Provider Demographics
NPI:1285239087
Name:MINIARD, CARRIE L (LCSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:MINIARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SLEATER KINNEY RD SE STE B189
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1150
Mailing Address - Country:US
Mailing Address - Phone:907-978-1943
Mailing Address - Fax:
Practice Address - Street 1:250 CUSHMAN ST STE 4F
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4665
Practice Address - Country:US
Practice Address - Phone:907-978-1943
Practice Address - Fax:360-838-4806
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615093371041C0700X
FLTPSW45751041C0700X
AK2094091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical