Healthcare Provider Details

I. General information

NPI: 1699897728
Provider Name (Legal Business Name): THEADIA LARUE CAREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THEADIA CARTER

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24424 W MCNICHOLS RD
DETROIT MI
48219-3653
US

IV. Provider business mailing address

22200 W. 11 MILE RD #181 T. L. C. BEHAVIORAL SERVICES, PLLC
SOUTHFIELD MI
48037
US

V. Phone/Fax

Practice location:
  • Phone: 313-255-0900
  • Fax:
Mailing address:
  • Phone: 248-838-9852
  • Fax: 866-769-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301076021
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301076021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: