Provider Demographics
NPI:1619456522
Name:CARRAHER, DAVID E
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:CARRAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:E
Other - Last Name:CARRAHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2642 MERRY OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6555
Mailing Address - Country:US
Mailing Address - Phone:336-327-1729
Mailing Address - Fax:
Practice Address - Street 1:2642 MERRY OAKS TRL
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6555
Practice Address - Country:US
Practice Address - Phone:336-327-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC013238101YM0800X, 1041C0700X
NCP0127321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3327939OtherTIN