Provider Demographics
NPI:1790859825
Name:CARLSON, LESLEY LOUISE (LICSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:LOUISE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S 48TH AVE # A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3614
Mailing Address - Country:US
Mailing Address - Phone:509-966-4027
Mailing Address - Fax:
Practice Address - Street 1:619 S 48TH AVE # A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3614
Practice Address - Country:US
Practice Address - Phone:509-966-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000078771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical