Doctor Name: | MR. STEPHEN HAYNES CARLSON |
NPI Number: | 1174758569 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 668 Quinan St Pinole, CA - 945641621 |
Business Phone Number: | 5107417286 |
Business Fax Number: | |
Mailing Address: | 2446 24th Ave, OAKLAND |
State: | CA |
Postal Code: | 946011267 |
Phone Number: | 5105334069 |
Fax Number: | |
NPI Enumeration Date: | 05/28/2009 |
NPI Last Update Date: | 05/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |