Healthcare Provider Details

I. General information

NPI: 1639034812
Provider Name (Legal Business Name): EMILLY MARIE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 WILLOWBROOK DR
SALTILLO MS
38866-6896
US

IV. Provider business mailing address

89 CLAYTON RD
ECRU MS
38841-7720
US

V. Phone/Fax

Practice location:
  • Phone: 662-760-5085
  • Fax:
Mailing address:
  • Phone: 662-296-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM11815
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: