| Doctor Name: | DR. DIANE A CARLSON |
| NPI Number: | 1104977271 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MFT |
| License Number: | MFT21255 |
| Business Practice Address: | 2525 Via Pisa Del Mar, CA - 920143815 |
| Business Phone Number: | 8588470638 |
| Business Fax Number: | |
| Mailing Address: | 2525 Via Pisa, DEL MAR |
| State: | CA |
| Postal Code: | 92014 |
| Phone Number: | 8588470638 |
| Fax Number: | |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MFT21255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |