Individual
DIANA CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
950 EBBETS DR SW, TUMWATER, WA 98512-4609
(360) 515-2888
Mailing address
950 EBBETS DR SW, TUMWATER, WA 98512-4609
(360) 515-2888
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
WA
106H00000X
Marriage & Family Therapist
Primary
60969570
WA
Other
Enumeration date
08/14/2013
Last updated
08/10/2021
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