Healthcare Provider Details

I. General information

NPI: 1164858932
Provider Name (Legal Business Name): THERESA LORELLE CARTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEORGIA THERESA LORELLE CARTER LCSW

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 266645
FRESNO CA
93729
US

IV. Provider business mailing address

PO BOX 266645
FRESNO CA
93729
US

V. Phone/Fax

Practice location:
  • Phone: 415-818-2352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW130298
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: