Provider Demographics
NPI:1598537557
Name:CARTER, BREANNA (LLMSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:BRE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-0609
Mailing Address - Country:US
Mailing Address - Phone:616-327-2405
Mailing Address - Fax:
Practice Address - Street 1:1750 GODFREY AVE SW APT 2
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-1306
Practice Address - Country:US
Practice Address - Phone:320-979-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula