Provider Demographics
NPI:1790278919
Name:DENT, CARLA MARIE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:DENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:QUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123-0857
Mailing Address - Country:US
Mailing Address - Phone:480-352-7624
Mailing Address - Fax:
Practice Address - Street 1:8902 E VIA LINDA # 110-163
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5416
Practice Address - Country:US
Practice Address - Phone:602-930-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical