Provider Demographics
NPI:1861680936
Name:WILSON, CAROLYN FREEMAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:FREEMAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NW 78TH WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1437
Mailing Address - Country:US
Mailing Address - Phone:954-793-3201
Mailing Address - Fax:954-473-1621
Practice Address - Street 1:501 NW 78TH WAY
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1437
Practice Address - Country:US
Practice Address - Phone:954-793-3201
Practice Address - Fax:954-473-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical