Provider Demographics
NPI:1265969463
Name:CARLSON, KRISTINA (LMHC, LCDP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LMHC, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 HILL FARM RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6936
Mailing Address - Country:US
Mailing Address - Phone:401-575-8559
Mailing Address - Fax:
Practice Address - Street 1:2845 POST RD STE 307
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3145
Practice Address - Country:US
Practice Address - Phone:401-528-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00715101YA0400X
CT6070101YM0800X, 101YP2500X
RIMHC01113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional