Healthcare Provider Details

I. General information

NPI: 1144562323
Provider Name (Legal Business Name): CARTER AND MAY, QMHP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 2ND ST STE B
PIKEVILLE KY
41501-4069
US

IV. Provider business mailing address

178 2ND ST STE B
PIKEVILLE KY
41501-4069
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-1287
  • Fax: 606-509-2345
Mailing address:
  • Phone: 606-432-1287
  • Fax: 606-509-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberKY-0222
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3441
License Number StateKY

VIII. Authorized Official

Name: MRS. LISA MAY
Title or Position: OWNER/LPCA
Credential: LPCA
Phone: 606-432-1287