Provider Demographics
NPI:1710159108
Name:WORTHY, CARLIS
Entity Type:Individual
Prefix:
First Name:CARLIS
Middle Name:
Last Name:WORTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CARLIS
Other - Middle Name:HARRIS
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6272 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5333
Mailing Address - Country:US
Mailing Address - Phone:810-287-1009
Mailing Address - Fax:
Practice Address - Street 1:6272 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5333
Practice Address - Country:US
Practice Address - Phone:810-287-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)