Provider Demographics
NPI:1053677997
Name:CARTER, ADDIE B (MA, LLPC, RAC)
Entity Type:Individual
Prefix:
First Name:ADDIE
Middle Name:B
Last Name:CARTER
Suffix:
Gender:F
Credentials:MA, LLPC, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 535
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004
Mailing Address - Country:US
Mailing Address - Phone:269-998-6288
Mailing Address - Fax:
Practice Address - Street 1:5617 BLUE MEADOW CIR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-8225
Practice Address - Country:US
Practice Address - Phone:269-998-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6401011964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)