Provider Demographics
NPI:1609388040
Name:NANTAIS, CARRIE ANN-FLING (PHD, MDIV)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN-FLING
Last Name:NANTAIS
Suffix:
Gender:F
Credentials:PHD, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 AVERY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2068
Mailing Address - Country:US
Mailing Address - Phone:248-770-6339
Mailing Address - Fax:
Practice Address - Street 1:777 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2306
Practice Address - Country:US
Practice Address - Phone:248-770-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical