Provider Demographics
NPI:1922679067
Name:CARSON, JANET KATHLEEN (APCC)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:KATHLEEN
Last Name:CARSON
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 ROADRUNNER CT
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2617
Mailing Address - Country:US
Mailing Address - Phone:480-440-4207
Mailing Address - Fax:
Practice Address - Street 1:18 TECHNOLOGY DR STE 188
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2313
Practice Address - Country:US
Practice Address - Phone:949-922-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8699101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor