Healthcare Provider Details

I. General information

NPI: 1154186369
Provider Name (Legal Business Name): TANETTA HIGHTOWER CARTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 CAMPBELLTON RD SW
ATLANTA GA
30331-8013
US

IV. Provider business mailing address

2260 FAIRBURN RD SW UNIT 310874
ATLANTA GA
31131-2609
US

V. Phone/Fax

Practice location:
  • Phone: 404-919-6564
  • Fax:
Mailing address:
  • Phone: 404-919-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: