Provider Demographics
NPI:1760693568
Name:CAROLAN, MARSHA T (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:T
Last Name:CAROLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF FAMILY AND CHILD ECOLOGY
Mailing Address - Street 2:MICHIGAN STATE UNIVERSITY
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1030
Mailing Address - Country:US
Mailing Address - Phone:517-432-3327
Mailing Address - Fax:517-432-3320
Practice Address - Street 1:329 OLIN HEALTH CENTER
Practice Address - Street 2:MICHIGAN STATE UNIVERSITY
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1030
Practice Address - Country:US
Practice Address - Phone:517-432-3327
Practice Address - Fax:517-432-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist