Provider Demographics
NPI:1457556128
Name:LEGERE, CARLS MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:CARLS
Middle Name:MARIE
Last Name:LEGERE
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 1:312 SUPERIOR MALL
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3833
Mailing Address - Country:US
Mailing Address - Phone:810-987-2681
Mailing Address - Fax:810-987-2784
Practice Address - Street 1:312 SUPERIOR MALL
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3833
Practice Address - Country:US
Practice Address - Phone:810-987-2681
Practice Address - Fax:810-987-2784
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health