Provider Demographics
NPI:1053422832
Name:CARR, CAROL SUSAN (MFT)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUSAN
Last Name:CARR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27972
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-1972
Mailing Address - Country:US
Mailing Address - Phone:858-646-9626
Mailing Address - Fax:
Practice Address - Street 1:16870 W BERNARDO DR STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1678
Practice Address - Country:US
Practice Address - Phone:858-646-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist