Healthcare Provider Details

I. General information

NPI: 1689264855
Provider Name (Legal Business Name): CARTER CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 YORK RD STE 103
BALTIMORE MD
21212-3849
US

IV. Provider business mailing address

PO BOX 99778
RALEIGH NC
27624-9778
US

V. Phone/Fax

Practice location:
  • Phone: 919-848-0132
  • Fax: 919-848-0277
Mailing address:
  • Phone: 919-423-0267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MYLEME OJINGA HARRISON
Title or Position: CEO/OWNER
Credential:
Phone: 919-848-0132