Provider Demographics
NPI:1295244838
Name:TIMBERMAN, CARSON MARIE (CDCA)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:MARIE
Last Name:TIMBERMAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:MARIE
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18003 WOODSFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-1392
Mailing Address - Country:US
Mailing Address - Phone:740-732-5988
Mailing Address - Fax:740-732-4154
Practice Address - Street 1:18003 WOODSFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1392
Practice Address - Country:US
Practice Address - Phone:740-732-5988
Practice Address - Fax:740-732-4154
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.172861101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator