Provider Demographics
NPI:1568622561
Name:MCCARTY, CARRIE LYNN (BS)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:PEMBROKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6379 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9566
Mailing Address - Country:US
Mailing Address - Phone:989-777-4357
Mailing Address - Fax:989-777-7257
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-4357
Practice Address - Fax:989-777-7257
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)