Provider Demographics
NPI:1275767600
Name:CORLEW-THAYER, CARRIE (LPC, CADC-M, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:CORLEW-THAYER
Suffix:
Gender:F
Credentials:LPC, CADC-M, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13336 TUSCOLA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1870
Mailing Address - Country:US
Mailing Address - Phone:810-515-5269
Mailing Address - Fax:
Practice Address - Street 1:11831 MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8487
Practice Address - Country:US
Practice Address - Phone:989-341-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-04516101YA0400X
MI6401011318101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional