Provider Demographics
NPI:1952711087
Name:CARTER, CHERILYN ELAINE (BSW/LSW MA/LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHERILYN
Middle Name:ELAINE
Last Name:CARTER
Suffix:
Gender:F
Credentials:BSW/LSW MA/LPC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BRANTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW/LBSW MA/LPC
Mailing Address - Street 1:18820 HAMPSHIRE ST
Mailing Address - Street 2:LATHRUP VILLAGE
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4454
Mailing Address - Country:US
Mailing Address - Phone:248-552-8426
Mailing Address - Fax:
Practice Address - Street 1:1025 E FOREST AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1024
Practice Address - Country:US
Practice Address - Phone:313-213-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003217101YP2500X
MI68020604901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical