Provider Demographics
NPI:1386211225
Name:CARR, PHOEBE C
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:C
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 N LUMBERJACK RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48877-8703
Mailing Address - Country:US
Mailing Address - Phone:810-772-3651
Mailing Address - Fax:
Practice Address - Street 1:623 W WARWICK DR STE 2
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1177
Practice Address - Country:US
Practice Address - Phone:989-285-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician