Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY 8159 | FL |
Y | 103TC1900X | Counseling Psychologist | PY 8159 | FL |
NPI | 1225347974 |
---|---|
Provider Name | Dr. Carson Christopher Ham |
First Address | Lakeland, FL 33811-1442 |
Second Address | Lakeland, FL 33811-1442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 14/03/2013 |