Provider Demographics
NPI:1427032861
Name:CARTER, SUSAN MARIE (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3335
Mailing Address - Country:US
Mailing Address - Phone:269-340-0870
Mailing Address - Fax:616-369-5583
Practice Address - Street 1:3918 CRICKET LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3335
Practice Address - Country:US
Practice Address - Phone:269-340-0870
Practice Address - Fax:616-369-5583
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI219007449Medicaid
MI680H010110OtherBCBS
MI680H045020OtherBCBS PPO
MIN98950001Medicare ID - Type Unspecified