Healthcare Provider Details

I. General information

NPI: 1669336418
Provider Name (Legal Business Name): MARCUS DEWAYNE CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11627 BROOKSHIRE AVE
DOWNEY CA
90241-4911
US

IV. Provider business mailing address

2033 E 4TH ST APT 308
LOS ANGELES CA
90033-4361
US

V. Phone/Fax

Practice location:
  • Phone: 562-469-6500
  • Fax:
Mailing address:
  • Phone: 213-422-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: