Healthcare Provider Details

I. General information

NPI: 1336862986
Provider Name (Legal Business Name): STEPHANIE LEE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 BRYNN MARR RD # 179
JACKSONVILLE NC
28546-5705
US

IV. Provider business mailing address

216 BRYNN MARR RD # 179
JACKSONVILLE NC
28546-5705
US

V. Phone/Fax

Practice location:
  • Phone: 305-303-8775
  • Fax:
Mailing address:
  • Phone: 305-303-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: