Individual
DR. CAROL VICTOR CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DOCTORATE - PHD
Contact information
Practice address
4199 CAMPUS DR STE 550, IRVINE, CA 92612-4694
(510) 444-1110
(949) 885-8885
Mailing address
405 ROCKEFELLER UNIT 906, IRVINE, CA 92612-7192
(510) 444-1110
(949) 885-8885
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY14518
CA
103TC0700X
Clinical Psychologist
PSY14518
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PL145180
BLUE SHIELD PROVIDER #
CA
Enumeration date
04/16/2007
Last updated
06/05/2024
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