Provider Demographics
NPI:1023162377
Name:CARLSON, SANDRA S
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:S
Last Name:CARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 BO JACK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1534
Mailing Address - Country:US
Mailing Address - Phone:713-896-8813
Mailing Address - Fax:713-937-4879
Practice Address - Street 1:4119 MONTROSE BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-4963
Practice Address - Country:US
Practice Address - Phone:713-522-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSO24341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical