Healthcare Provider Details

I. General information

NPI: 1669353991
Provider Name (Legal Business Name): TERESA KAY CARTER LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILKESBORO ST
MOCKSVILLE NC
27028-2321
US

IV. Provider business mailing address

1932 HARPER RD
CLEMMONS NC
27012-8622
US

V. Phone/Fax

Practice location:
  • Phone: 336-751-5014
  • Fax: 336-751-0036
Mailing address:
  • Phone: 336-918-6294
  • Fax: 336-751-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPO22554
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022554
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: