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General NPI Number Information
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NPI Number | 1497868590
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Entity Type | Individual
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Provider Name | CAROL S AGNEW LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 42627 GARFIELD RD STE 217
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5032
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Country | US
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Telephone | 248-210-5018
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Fax |
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Provider Business Mailing Address
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Address Line | 42627 GARFIELD RD STE 217
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5032
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Country | US
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Telephone | 248-210-5018
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4101006139
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006139
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License Number State | MI
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