Provider Demographics
NPI:1700578028
Name:CARLISLE, CARRIE ALICIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ALICIA
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 W INDIAN ROCKS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4980
Mailing Address - Country:US
Mailing Address - Phone:407-267-3789
Mailing Address - Fax:
Practice Address - Street 1:112 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5011
Practice Address - Country:US
Practice Address - Phone:208-465-5433
Practice Address - Fax:208-466-5802
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID43622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker