Basic Information
| Provider Information | |||||||||
| NPI: | 1497024897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEAD | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 932 HUBBARD AVE | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485034938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102335145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 CHIPPEWA ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485031552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102329950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401012820 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.