Provider Demographics
NPI:1740329663
Name:CARLSON, MATTHEW ALLEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:CARLSON
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Gender:M
Credentials:PSYD
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Mailing Address - Street 1:55 CARLTON ST
Mailing Address - Street 2:COUNSELING AND PSYCHIATRIC SERVICES
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1503
Mailing Address - Country:US
Mailing Address - Phone:610-266-0610
Mailing Address - Fax:610-266-0292
Practice Address - Street 1:55 CARLTON ST
Practice Address - Street 2:COUNSELING AND PSYCHIATRIC SERVICES
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1503
Practice Address - Country:US
Practice Address - Phone:706-542-2273
Practice Address - Fax:706-542-8661
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY003478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50056214OtherCAPITAL BLUE CROSS