| Doctor Name: | MR. CARLSON MCCOY PENDLETON |
| NPI Number: | 1053375899 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 0904001601 |
| Business Practice Address: | 100 Emancipation Dr Hampton, VA - 236670001 |
| Business Phone Number: | 7577229961 |
| Business Fax Number: | |
| Mailing Address: | 122 Taylor Ave E, HAMPTON |
| State: | VA |
| Postal Code: | 236631614 |
| Phone Number: | 7577226900 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0904001601 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |