Healthcare Provider Details

I. General information

NPI: 1649428673
Provider Name (Legal Business Name): VICKI CARTER PSYD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JOHN H CHAFEE BLVD
NEWPORT RI
02840-1034
US

IV. Provider business mailing address

610 WAMPANOAG TRL
RIVERSIDE RI
02915-1504
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-2160
  • Fax:
Mailing address:
  • Phone: 401-431-9870
  • Fax: 401-437-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01119
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2697
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: