Healthcare Provider Details

I. General information

NPI: 1740003342
Provider Name (Legal Business Name): SARAH CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 68 CR 41 PRIVATE DR 1098
VELARDE NM
87582
US

IV. Provider business mailing address

HWY 68 CR 41 PRIVATE DR 1098
VELARDE NM
87582
US

V. Phone/Fax

Practice location:
  • Phone: 505-852-6709
  • Fax:
Mailing address:
  • Phone: 505-852-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: