Provider Demographics
NPI:1699857219
Name:CARTER, SUSAN H (ACSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:CARTER
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W MAIN ST
Mailing Address - Street 2:#300
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1445
Mailing Address - Country:US
Mailing Address - Phone:810-220-7974
Mailing Address - Fax:866-200-8576
Practice Address - Street 1:409 W MAIN ST
Practice Address - Street 2:#300
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1445
Practice Address - Country:US
Practice Address - Phone:810-220-7974
Practice Address - Fax:866-200-8576
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801019364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON99990Medicare UPIN