Provider Demographics
NPI:1336219021
Name:SARVIS, CARSON MCKNIGHT (MED LCMHC)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:MCKNIGHT
Last Name:SARVIS
Suffix:
Gender:F
Credentials:MED LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 DOLLEY MADISON RD STE 410
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5167
Mailing Address - Country:US
Mailing Address - Phone:336-292-1510
Mailing Address - Fax:336-292-0679
Practice Address - Street 1:445 DOLLEY MADISON RD STE 410
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5167
Practice Address - Country:US
Practice Address - Phone:336-292-1510
Practice Address - Fax:336-292-0679
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10604OtherBCBS
NC6102900Medicaid