Healthcare Provider Details

I. General information

NPI: 1124848437
Provider Name (Legal Business Name): JENNIFER CARTER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 11TH ST
ENCINITAS CA
92024-6604
US

IV. Provider business mailing address

515 COLE RANCH RD
ENCINITAS CA
92024-6520
US

V. Phone/Fax

Practice location:
  • Phone: 760-456-7462
  • Fax: 858-863-6936
Mailing address:
  • Phone: 760-518-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: