Provider Demographics
NPI:1679334809
Name:CAROL B. CARLSON MENTAL HEATLH COUNSELING, P.C.
Entity Type:Organization
Organization Name:CAROL B. CARLSON MENTAL HEATLH COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:585-466-0545
Mailing Address - Street 1:2698 BAIRD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1224
Mailing Address - Country:US
Mailing Address - Phone:585-466-0545
Mailing Address - Fax:585-504-7019
Practice Address - Street 1:490 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3506
Practice Address - Country:US
Practice Address - Phone:585-466-0545
Practice Address - Fax:585-504-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty