Provider Demographics
NPI:1912329376
Name:CARLSON, JOSHUA ERIK (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ERIK
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4446
Mailing Address - Country:US
Mailing Address - Phone:217-222-0034
Mailing Address - Fax:217-592-0391
Practice Address - Street 1:205 S 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4446
Practice Address - Country:US
Practice Address - Phone:217-222-0034
Practice Address - Fax:217-592-0391
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0179321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical