Provider Demographics
NPI:1336169267
Name:EVERTSON, CARROLL (LMHC)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:
Last Name:EVERTSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 VINKEMULDER RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3433
Mailing Address - Country:US
Mailing Address - Phone:954-967-6300
Mailing Address - Fax:
Practice Address - Street 1:1150 HIBISCUS DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4554
Practice Address - Country:US
Practice Address - Phone:954-967-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MH6745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health