Provider Demographics
NPI:1972038206
Name:CARLSON, MALARIE (LAPC)
Entity Type:Individual
Prefix:
First Name:MALARIE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:MALARIE
Other - Middle Name:
Other - Last Name:DESLAURIERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4737
Mailing Address - Country:US
Mailing Address - Phone:701-746-0405
Mailing Address - Fax:701-746-5918
Practice Address - Street 1:211 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4737
Practice Address - Country:US
Practice Address - Phone:701-746-0405
Practice Address - Fax:701-746-5918
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND868-4-1-16A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional