Provider Demographics
NPI:1811234107
Name:ADKINS-CARLSON, DORRAINE SUE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DORRAINE
Middle Name:SUE
Last Name:ADKINS-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 1:13335 NORWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-4108
Mailing Address - Country:US
Mailing Address - Phone:218-820-2228
Mailing Address - Fax:218-829-9392
Practice Address - Street 1:13335 NORWAY DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-4108
Practice Address - Country:US
Practice Address - Phone:218-820-2228
Practice Address - Fax:218-829-9392
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical