Healthcare Provider Details

I. General information

NPI: 1104996180
Provider Name (Legal Business Name): CARIE NIELSON CARTER L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 CHRISTIANSBURG PIKE NE
PILOT VA
24138
US

IV. Provider business mailing address

4410 CHRISTIANSBURG PIKE NE
PILOT VA
24138
US

V. Phone/Fax

Practice location:
  • Phone: 540-745-3887
  • Fax: 540-745-7188
Mailing address:
  • Phone: 540-745-3887
  • Fax: 540-745-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: