Individual
CAROLYN CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., LADC
Contact information
Practice address
149 W CORNWALL RD, SHARON, CT 06069-2105
(860) 672-6689
(860) 672-3021
Mailing address
38 OLD RIDGEBURY RD, DANBURY, CT 06810-5128
(203) 792-4515
(203) 748-2604
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000052
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004257516
—
CT
Enumeration date
12/08/2006
Last updated
01/10/2012
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