Provider Demographics
NPI:1043723737
Name:CARTER, OLIVIA (BA MAED)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:BA MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CADILLAC SQUARE
Mailing Address - Street 2:STE #3000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226
Mailing Address - Country:US
Mailing Address - Phone:313-736-2302
Mailing Address - Fax:
Practice Address - Street 1:2712 GRATIOT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-962-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management