Provider Demographics
NPI:1144305434
Name:KIDD, CARLA HARMON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:HARMON
Last Name:KIDD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 W PARK ROW DR
Mailing Address - Street 2:SUITE B-5 #149
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2273
Mailing Address - Country:US
Mailing Address - Phone:817-480-8776
Mailing Address - Fax:817-277-5454
Practice Address - Street 1:4275 LITTLE RD
Practice Address - Street 2:SUITE 205-5
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5600
Practice Address - Country:US
Practice Address - Phone:817-480-8776
Practice Address - Fax:817-277-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health