Provider Demographics
NPI:1184751984
Name:CAREY, LADONNA SELBY (MA)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:SELBY
Last Name:CAREY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N EASTMAN RD
Mailing Address - Street 2:STE 122
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3163
Mailing Address - Country:US
Mailing Address - Phone:423-230-0909
Mailing Address - Fax:423-357-7755
Practice Address - Street 1:1201 N EASTMAN RD
Practice Address - Street 2:STE 122
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3163
Practice Address - Country:US
Practice Address - Phone:423-230-0909
Practice Address - Fax:423-357-7755
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE1528103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service