Provider Demographics
NPI:1366097883
Name:CARLSON, ADAM MICHAEL (MSW, LCSW-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MSW, LCSW-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5029
Mailing Address - Country:US
Mailing Address - Phone:252-321-8080
Mailing Address - Fax:252-321-7999
Practice Address - Street 1:4054 S MEMORIAL DR STE K
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8690
Practice Address - Country:US
Practice Address - Phone:252-561-8112
Practice Address - Fax:252-561-7455
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25691101YA0400X
NCC0141171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)