Provider Demographics
NPI:1437751583
Name:CARR, AUDREY ANNE (BA)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:ANNE
Last Name:CARR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:ANNE
Other - Last Name:LUSSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:8 KILBURN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-7321
Mailing Address - Country:US
Mailing Address - Phone:508-979-1122
Mailing Address - Fax:508-979-1126
Practice Address - Street 1:8 KILBURN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7321
Practice Address - Country:US
Practice Address - Phone:508-979-1122
Practice Address - Fax:508-979-1126
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)