Healthcare Provider Details

I. General information

NPI: 1477171502
Provider Name (Legal Business Name): MYSHELLIA CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E NORTHWOOD AVE
COLUMBUS OH
43201-1383
US

IV. Provider business mailing address

450 E NORTHWOOD AVE
COLUMBUS OH
43201-1383
US

V. Phone/Fax

Practice location:
  • Phone: 937-626-0134
  • Fax:
Mailing address:
  • Phone: 937-626-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2606379
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606379
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: