| Carlson Counseling Connection Inc | |
|
3139 N Lincoln Ave Ste 227 Chicago IL 60657-3173 | |
| (630) 310-6756 | |
| Not Available |
| Full Name | Carlson Counseling Connection Inc |
|---|---|
| Speciality | Social Worker |
| Location | 3139 N Lincoln Ave Ste 227, Chicago, Illinois |
| Authorized Official Name and Position | Lisa Marie Carlson (CLINICIAN/OWNER) |
| Authorized Official Contact | 6303106756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlson Counseling Connection Inc 3139 N Lincoln Ave Ste 227 Chicago IL 60657-3173 Ph: (630) 310-6756 | Carlson Counseling Connection Inc 3139 N Lincoln Ave Ste 227 Chicago IL 60657-3173 Ph: (630) 310-6756 |
| NPI Number | 1558963561 |
|---|---|
| Provider Enumeration Date | 11/13/2020 |
| Last Update Date | 11/13/2020 |
| Certification Date | 11/13/2020 |
| Medicare PECOS PAC ID | 8325418965 |
|---|---|
| Medicare Enrollment ID | O20221223000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558963561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa Marie Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629445200 PECOS PAC ID: 8527313832 Enrollment ID: I20180608001404 |
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