Healthcare Provider Details

I. General information

NPI: 1073320974
Provider Name (Legal Business Name): MRS. CARTER HERNDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MATTHEWS MINT HILL RD STE 103
MATTHEWS NC
28105-2894
US

IV. Provider business mailing address

317 MATTHEWS MINT HILL RD STE 103
MATTHEWS NC
28105-2894
US

V. Phone/Fax

Practice location:
  • Phone: 704-975-4093
  • Fax:
Mailing address:
  • Phone: 704-975-4093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22892
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: