Individual
JEFFREY JOHN CARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LADC
Contact information
Practice address
1405 SAN JUAN HILLS DR UNIT 105, LAS VEGAS, NV 89134-6390
(770) 364-4402
Mailing address
1405 SAN JUAN HILLS DR, UNIT 105, LAS VEGAS, NV 89134-6390
(770) 364-4402
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1269
NV
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C10131
CPCI
NV
Enumeration date
11/26/2012
Last updated
04/08/2019
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