Provider Demographics
NPI:1427712298
Name:CARROTHERS WELLNESS, PLLC
Entity type:Organization
Organization Name:CARROTHERS WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:734-776-5665
Mailing Address - Street 1:23565 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3348
Mailing Address - Country:US
Mailing Address - Phone:734-776-5665
Mailing Address - Fax:
Practice Address - Street 1:122 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8900
Practice Address - Country:US
Practice Address - Phone:734-776-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty