Provider Demographics
NPI:1972235000
Name:CARSON, RICHARD
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:CARSON
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 1:19711 WARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1824
Mailing Address - Country:US
Mailing Address - Phone:877-553-0811
Mailing Address - Fax:313-447-1647
Practice Address - Street 1:19711 WARRINGTON DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1824
Practice Address - Country:US
Practice Address - Phone:877-553-0811
Practice Address - Fax:313-447-1647
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator