Provider Demographics
NPI:1336339944
Name:CARLSON, GENEVIEVE RANSOM (MSW)
Entity Type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:RANSOM
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:GENEVIEVE
Other - Middle Name:PINCHOT
Other - Last Name:RANSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:1813 BUTTERMILK LN
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6917
Mailing Address - Country:US
Mailing Address - Phone:707-825-6658
Mailing Address - Fax:707-825-6658
Practice Address - Street 1:720 WOOD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4413
Practice Address - Country:US
Practice Address - Phone:707-268-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW21923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health