Individual
MS. KRISTINE LEIGH CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1615 OJO COURT, FARMINGTON, NM 87401-5638
(505) 564-4804
(505) 564-4857
Mailing address
7601 OLD AZTEC HWY, FLORA VISTA, NM 87415-9632
(505) 326-0664
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OOR75E
BCBS PROVIDER #
NM
Enumeration date
08/01/2006
Last updated
03/24/2020
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