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General NPI Number Information
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NPI Number | 1962890798
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Entity Type | Individual
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Provider Name | KRISTEN CARNEY LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/01/2015
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 17320 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2100
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Country | US
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Telephone | 248-792-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 15812 WINDMILL POINTE DR
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1842
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Country | US
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Telephone | 313-829-1740
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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 | 6801093053
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License Number State | MI
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