Provider Demographics
NPI:1477228302
Name:DUDLEY, CARRIE Y (MS, LPC, DP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:Y
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MS, LPC, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-0210
Mailing Address - Country:US
Mailing Address - Phone:989-999-8463
Mailing Address - Fax:
Practice Address - Street 1:8702 WANDERING WAY
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9557
Practice Address - Country:US
Practice Address - Phone:989-999-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional