Provider Demographics
NPI:1710025408
Name:HERRELL, CARL MICHAEL (MSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:MICHAEL
Last Name:HERRELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 DREXEL ST
Mailing Address - Street 2:F2
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-6744
Mailing Address - Country:US
Mailing Address - Phone:313-303-6391
Mailing Address - Fax:
Practice Address - Street 1:220 BAGLEY ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1400
Practice Address - Country:US
Practice Address - Phone:313-965-2141
Practice Address - Fax:313-961-4612
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058523101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor