Provider Demographics
NPI:1114318524
Name:CHARLES, CAREY ANNE (PHD, MA,MA,MA)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:ANNE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PHD, MA,MA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34277 RAMBLE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-4206
Mailing Address - Country:US
Mailing Address - Phone:248-345-1366
Mailing Address - Fax:
Practice Address - Street 1:34277 RAMBLE HILLS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-4206
Practice Address - Country:US
Practice Address - Phone:248-345-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI002227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical