Healthcare Provider Details

I. General information

NPI: 1144631029
Provider Name (Legal Business Name): STEPHANIE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 WATERLOO BLVD SUITE 120
EXTON PA
19341-2603
US

IV. Provider business mailing address

390 WATERLOO BLVD SUITE 120
EXTON PA
19341
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH000810
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: