Provider Demographics
NPI:1699076950
Name:WEST, CAROLE E (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:E
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N GAINSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1938
Mailing Address - Country:US
Mailing Address - Phone:248-607-3455
Mailing Address - Fax:248-592-7053
Practice Address - Street 1:603 N GAINSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1938
Practice Address - Country:US
Practice Address - Phone:248-607-3455
Practice Address - Fax:248-592-7053
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4555001OtherPTAN