Healthcare Provider Details

I. General information

NPI: 1881281061
Provider Name (Legal Business Name): AVA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAMSTEIN GERMANY
APO AE
09094-0909
US

IV. Provider business mailing address

CMR 405 BOX 7160
APO AE
09034-0072
US

V. Phone/Fax

Practice location:
  • Phone: 440-941-6068
  • Fax:
Mailing address:
  • Phone: 440-941-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1000386
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: