Provider Demographics
NPI:1982784682
Name:MOTON, CARLA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JEAN
Last Name:MOTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:526 INDIGO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3402
Mailing Address - Country:US
Mailing Address - Phone:210-410-8153
Mailing Address - Fax:210-821-6121
Practice Address - Street 1:1635 NE LOOP 410
Practice Address - Street 2:S 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1625
Practice Address - Country:US
Practice Address - Phone:210-601-9888
Practice Address - Fax:210-821-6121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000316PMedicare ID - Type Unspecified