Provider Demographics
NPI:1952864126
Name:CONDER, CARRIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CONDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:WINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-2633
Mailing Address - Country:US
Mailing Address - Phone:574-350-6800
Mailing Address - Fax:
Practice Address - Street 1:107 N EDDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2920
Practice Address - Country:US
Practice Address - Phone:574-246-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical