Provider Demographics
NPI:1033417480
Name:PAPPAS, CARRIE ANN (MA,LLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 ARROYO VISTA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9400
Mailing Address - Country:US
Mailing Address - Phone:616-625-9066
Mailing Address - Fax:616-451-9513
Practice Address - Street 1:655 KENMOOR AVE SE STE 303
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8622
Practice Address - Country:US
Practice Address - Phone:616-625-9066
Practice Address - Fax:616-369-5782
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002939101YM0800X
MI6301012126103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist