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General NPI Number Information
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NPI Number | 1275767600
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Entity Type | Individual
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Provider Name | CARRIE CORLEW-THAYER LPC, CADC-M, QMHP
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Gender | Female
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 209 E WASHINGTON AVE STE 330
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City | JACKSON
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State | MI
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Zip | 49201-2399
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Country | US
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Telephone | 810-515-5269
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Fax |
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Provider Business Mailing Address
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Address Line | 13035 N BRAY RD
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City | CLIO
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State | MI
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Zip | 48420-9111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1-04516
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401011318
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401011318
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License Number State | MI
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