Provider Demographics
NPI:1164502431
Name:CARTER, ROSLYN JO (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:JO
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6666 MELLOW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3765
Mailing Address - Country:US
Mailing Address - Phone:248-996-8569
Mailing Address - Fax:248-562-7119
Practice Address - Street 1:17356 W 12 MILE RD STE 203
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6316
Practice Address - Country:US
Practice Address - Phone:248-996-8569
Practice Address - Fax:248-562-7119
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004803101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor