Provider Demographics
NPI:1174740179
Name:SPIGHT-MACKEY, CARLA JEANNE
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JEANNE
Last Name:SPIGHT-MACKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JEANNE
Other - Last Name:SPIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LMSW
Mailing Address - Street 1:19318 ILENE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1446
Mailing Address - Country:US
Mailing Address - Phone:313-995-1945
Mailing Address - Fax:313-875-9058
Practice Address - Street 1:736 LOTHROP RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2715
Practice Address - Country:US
Practice Address - Phone:313-995-1945
Practice Address - Fax:313-875-9058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010734481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical