Healthcare Provider Details

I. General information

NPI: 1982924361
Provider Name (Legal Business Name): TRACEY TAYLOR CARTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 INTERSTATE PKWY STE B
AUGUSTA GA
30909-6481
US

IV. Provider business mailing address

2703 BIG DOG TRL
HEPHZIBAH GA
30815-4998
US

V. Phone/Fax

Practice location:
  • Phone: 706-751-7558
  • Fax: 706-364-0401
Mailing address:
  • Phone: 706-284-2752
  • Fax: 706-364-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC006844
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: