Provider Demographics
NPI:1740249788
Name:NIELSEN, CARLA LUDWIGSEN
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:LUDWIGSEN
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:LUDWIGSEN
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PH D
Mailing Address - Street 1:8340 BANDFORD WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2755
Mailing Address - Country:US
Mailing Address - Phone:919-676-9990
Mailing Address - Fax:919-848-6048
Practice Address - Street 1:8340 BANDFORD WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2755
Practice Address - Country:US
Practice Address - Phone:919-676-9990
Practice Address - Fax:919-848-6048
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical