Provider Demographics
NPI:1770764219
Name:MENKE, CARRIE SUE (MS LPC)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:SUE
Last Name:MENKE
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5124
Mailing Address - Country:US
Mailing Address - Phone:910-798-6463
Mailing Address - Fax:910-798-6481
Practice Address - Street 1:718 S 3RD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5124
Practice Address - Country:US
Practice Address - Phone:910-798-6463
Practice Address - Fax:910-798-6481
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health