Basic Information
| Provider Information | |||||||||
| NPI: | 1366097883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MSW, LCSW-A, LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523218080 | ||||||||
| FaxNumber: | 2523217999 | ||||||||
| Practice Location | |||||||||
| Address1: | 4054 S MEMORIAL DR STE K | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285908690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525618112 | ||||||||
| FaxNumber: | 2525617455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-25691 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | C014117 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.