Provider Demographics
NPI:1326388810
Name:HEAD, CARRIE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:M
Last Name:HEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19824 W CATAWBA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4046
Mailing Address - Country:US
Mailing Address - Phone:704-641-4515
Mailing Address - Fax:
Practice Address - Street 1:19824 W CATAWBA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4046
Practice Address - Country:US
Practice Address - Phone:704-641-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical