Provider Demographics
NPI:1215371026
Name:CAREY CHARLES PHD PC
Entity Type:Organization
Organization Name:CAREY CHARLES PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:MS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-345-1366
Mailing Address - Street 1:555 E. WILLIAM TOWER PLAZA
Mailing Address - Street 2:SUITE #23A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104
Mailing Address - Country:US
Mailing Address - Phone:248-345-1366
Mailing Address - Fax:
Practice Address - Street 1:555 E. WILLIAM TOWER PLAZA
Practice Address - Street 2:SUITE #23A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:248-345-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty