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Individual

MARISSA CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
201 N 8TH ST STE 4, SAINT MARIES, ID 83861-1869
(208) 597-7639
(208) 717-9450
Mailing address
13498 E LAY LN, MEDIMONT, ID 83842-9775
(208) 582-4024
(208) 717-9450

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
39959
ID
104100000X
Social Worker
Primary
LCSW-43558
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
39959
LICENSE
ID
Enumeration date
08/28/2020
Last updated
10/30/2024
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