Provider Demographics
NPI:1609355486
Name:BUCHOLTZ, CARRIE LYNN (MA LLPC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:BUCHOLTZ
Suffix:
Gender:F
Credentials:MA LLPC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9817 MARSALLE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-9682
Mailing Address - Country:US
Mailing Address - Phone:312-425-8768
Mailing Address - Fax:
Practice Address - Street 1:4902 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5474
Practice Address - Country:US
Practice Address - Phone:517-394-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016357101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor