Provider Demographics
NPI:1013245752
Name:HARVEY, CAROL A (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 NEWPORT RD STE 222
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-9235
Mailing Address - Country:US
Mailing Address - Phone:269-488-5929
Mailing Address - Fax:833-599-7700
Practice Address - Street 1:6100 NEWPORT RD STE 222
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-9235
Practice Address - Country:US
Practice Address - Phone:269-488-5929
Practice Address - Fax:833-599-7700
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013245752Medicaid