Provider Demographics
NPI:1124632344
Name:MICHAEL, CARRIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MCBRIDE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2248
Mailing Address - Country:US
Mailing Address - Phone:931-637-4657
Mailing Address - Fax:
Practice Address - Street 1:367 RIVERSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8985
Practice Address - Country:US
Practice Address - Phone:931-637-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health