Provider Demographics
NPI:1821320623
Name:CARTER, KIRT ERIC
Entity Type:Individual
Prefix:MR
First Name:KIRT
Middle Name:ERIC
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-1511
Mailing Address - Country:US
Mailing Address - Phone:574-612-2106
Mailing Address - Fax:
Practice Address - Street 1:629 W CLOVERLAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-1006
Practice Address - Country:US
Practice Address - Phone:906-932-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010468121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical