Provider Demographics
NPI:1881023018
Name:CARLSON, AMY KATHARINE (LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHARINE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81156
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-1156
Mailing Address - Country:US
Mailing Address - Phone:208-200-1123
Mailing Address - Fax:
Practice Address - Street 1:315 5TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5025
Practice Address - Country:US
Practice Address - Phone:907-374-7776
Practice Address - Fax:800-988-1650
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12371041C0700X
IDLMSW-280911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical