MEDICARE: MRS. ANTITA CARTER LPC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC007059	GA

General Provider Information

NPI Number	:	1174864714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANTITA CARTER LPC

Provider Business Mailing Address
First Line	:	1050 REDAN TRCE
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2900
Country	:	US
Telephone Number	:	229-699-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 REDAN TRCE
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2900
Country	:	US
Telephone Number	:	229-699-4666
Fax Number	:

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	10/17/2016

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