Healthcare Provider Details

I. General information

NPI: 1891623476
Provider Name (Legal Business Name): TIMOTHY GERALD CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S INDIAN HILL BLVD
CLAREMONT CA
91711-5444
US

IV. Provider business mailing address

20599 BLOOMFIELD RD
RIVERSIDE CA
92508-2916
US

V. Phone/Fax

Practice location:
  • Phone: 909-399-2222
  • Fax:
Mailing address:
  • Phone: 951-263-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: