Provider Demographics
NPI:1740402700
Name:CARLSON, SARA CAROLYN (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:CAROLYN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4357 OAKMEDE LANE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR TOWNSHIP
Mailing Address - State:MN
Mailing Address - Zip Code:55110
Mailing Address - Country:US
Mailing Address - Phone:651-484-7970
Mailing Address - Fax:651-737-1686
Practice Address - Street 1:EVOLVING WOMAN ENTERPRISES, INC.
Practice Address - Street 2:7400 METRO BLVD.
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:651-484-7970
Practice Address - Fax:651-737-1686
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist