Healthcare Provider Details

I. General information

NPI: 1699447672
Provider Name (Legal Business Name): SHANYA E CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

IV. Provider business mailing address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-8282
  • Fax: 843-761-7308
Mailing address:
  • Phone: 843-761-8282
  • Fax: 843-761-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11861
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: