Provider Demographics
NPI:1083863476
Name:CARTER, LATANYA (PHD)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4736
Mailing Address - Country:US
Mailing Address - Phone:248-244-8644
Mailing Address - Fax:248-244-1330
Practice Address - Street 1:888 W BIG BEAVER RD
Practice Address - Street 2:SUITE 1450
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4736
Practice Address - Country:US
Practice Address - Phone:248-244-8644
Practice Address - Fax:248-244-1330
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical