| NPI | 1134595473 |
|---|---|
| Former Name | COLLEEN DIANE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1907095) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC00822) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2020-03-25 |