Provider Demographics
NPI:1669758157
Name:DAVID, CARRIE ANN (LCPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:DAVID
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-0222
Mailing Address - Country:US
Mailing Address - Phone:406-852-0056
Mailing Address - Fax:406-234-9333
Practice Address - Street 1:2200 BOX ELDER ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2899
Practice Address - Country:US
Practice Address - Phone:406-852-0056
Practice Address - Fax:406-234-9333
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional