Healthcare Provider Details

I. General information

NPI: 1386757227
Provider Name (Legal Business Name): CHRIS GEORGE CARTER BA SW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W. MEMORIAL DR.
HOUGHTON MI
49931
US

IV. Provider business mailing address

901 W. MEMORIAL DR.
HOUGHTON MI
49931
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-9400
  • Fax: 906-483-0269
Mailing address:
  • Phone: 906-482-9400
  • Fax: 906-483-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802082870
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: