Provider Demographics
NPI:1467628479
Name:HOWARD, CAROL ANN (MA LIMITED LICENSE P)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MA LIMITED LICENSE P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 NEWPORT ROAD
Mailing Address - Street 2:SUITE 222 JOHN T GALLAGHER AND ASSOCIATES PLC
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-9235
Mailing Address - Country:US
Mailing Address - Phone:269-324-1248
Mailing Address - Fax:269-324-1263
Practice Address - Street 1:6100 NEWPORT ROAD
Practice Address - Street 2:SUITE 222 JOHN T GALLAGHER AND ASSOCIATES PLC
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-9235
Practice Address - Country:US
Practice Address - Phone:269-324-1248
Practice Address - Fax:269-324-1263
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist