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General NPI Number Information
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NPI Number | 1285281196
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Entity Type | Individual
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Provider Name | CHRISTINE NAN CARROTHERS LPC
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 41740 6 MILE RD STE 103
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City | NORTHVILLE
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State | MI
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Zip | 48168-4383
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Country | US
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Telephone | 734-542-6969
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Fax | 734-542-6967
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Provider Business Mailing Address
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Address Line | 23565 WESLEY DR
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City | FARMINGTON
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State | MI
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Zip | 48335-3348
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Country | US
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Telephone | 734-776-5665
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401010227
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License Number State | MI
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