Healthcare Provider Details

I. General information

NPI: 1366370496
Provider Name (Legal Business Name): NINA CARRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N CAMPBELL RD
ROYAL OAK MI
48067-1555
US

IV. Provider business mailing address

930 W 11 MILE RD
BERKLEY MI
48072-3028
US

V. Phone/Fax

Practice location:
  • Phone: 248-410-7535
  • Fax:
Mailing address:
  • Phone: 248-410-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: NINA CARRY
Title or Position: OWNER
Credential:
Phone: 248-410-7535