Provider Demographics
NPI:1912359399
Name:THOMAS CARR, CHRISTY MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:THOMAS CARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 SAN CLEMENTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7486
Mailing Address - Country:US
Mailing Address - Phone:575-932-9593
Mailing Address - Fax:
Practice Address - Street 1:3855 FOOTHILLS RD STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-520-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-094871041C0700X
NMC-107301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical