Provider Demographics
NPI:1407339682
Name:CARSON, KAITLIN (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:MS
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:KERSCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:27640 DANIEL CT
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-6317
Mailing Address - Country:US
Mailing Address - Phone:586-863-6302
Mailing Address - Fax:
Practice Address - Street 1:9397 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-927-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical