Provider Demographics
NPI:1649942699
Name:CARSON, MEGAN W (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:W
Last Name:CARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1629
Mailing Address - Country:US
Mailing Address - Phone:478-960-1599
Mailing Address - Fax:
Practice Address - Street 1:1044 WASHINGTON AVE STE 106
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-0664
Practice Address - Country:US
Practice Address - Phone:478-960-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW007427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker