Provider Demographics
NPI:1851756019
Name:STRONG, CARRIE ANN (BA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:STRONG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3138 DAGGITT DR
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9742
Mailing Address - Country:US
Mailing Address - Phone:517-392-1995
Mailing Address - Fax:
Practice Address - Street 1:3138 DAGGITT DR
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9742
Practice Address - Country:US
Practice Address - Phone:517-392-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI171M00000XMedicaid