Provider Demographics
NPI:1609093475
Name:CARLSON, SHARON S (LMFT& LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMFT& LPC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT & LPC
Mailing Address - Street 1:200 OAKMONT CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2283
Mailing Address - Country:US
Mailing Address - Phone:205-837-4863
Mailing Address - Fax:205-871-3522
Practice Address - Street 1:720 SHADES CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4458
Practice Address - Country:US
Practice Address - Phone:205-837-4863
Practice Address - Fax:205-871-3522
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1402101YP2500X
AL47106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517424Medicare UPIN