Healthcare Provider Details

I. General information

NPI: 1619643400
Provider Name (Legal Business Name): NYCOLE C CARTER BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 01/14/2024
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

715 S PLUM ST
MARYSVILLE OH
43040-1631
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 937-644-9192
  • Fax: 937-644-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS.2106796
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2106796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: