MEDICARE: SAMARIA LATRICE CARTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	106E00000X	Assistant Behavior Analyst
4	106S00000X	Behavior Technician
5	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134000565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMARIA LATRICE CARTER

Provider Business Mailing Address
First Line	:	2914 KENDALE DR APT 103
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3529
Country	:	US
Telephone Number	:	419-266-9558
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914 KENDALE DR APT 103
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3529
Country	:	US
Telephone Number	:	419-266-9558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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