Healthcare Provider Details

I. General information

NPI: 1194779868
Provider Name (Legal Business Name): DANA M CARTER MSW/LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA GIBSON

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E WALNUT ST SUITE G
COLUMBIA MO
65203-4505
US

IV. Provider business mailing address

19 E WALNUT ST SUITE G
COLUMBIA MO
65203-4505
US

V. Phone/Fax

Practice location:
  • Phone: 573-356-8111
  • Fax: 573-634-4010
Mailing address:
  • Phone: 573-356-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002030044
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2002030044
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002030044
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2002030044
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: