Provider Demographics
NPI:1548634462
Name:COMRIE, CARTER FITZGERALD (MA, LLP)
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:FITZGERALD
Last Name:COMRIE
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 KING ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2161
Mailing Address - Country:US
Mailing Address - Phone:404-567-9801
Mailing Address - Fax:
Practice Address - Street 1:23400 PARK ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2545
Practice Address - Country:US
Practice Address - Phone:313-241-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301018158OtherMI LICENSE
MI14540758OtherCAQH