Provider Demographics
NPI:1497092720
Name:GENE, CARRIE LEE DYE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEE DYE
Last Name:GENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3247 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2412
Mailing Address - Country:US
Mailing Address - Phone:702-776-3500
Mailing Address - Fax:
Practice Address - Street 1:3247 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2412
Practice Address - Country:US
Practice Address - Phone:702-776-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X
NV8071-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No253J00000XAgenciesFoster Care Agency