Healthcare Provider Details

I. General information

NPI: 1417966474
Provider Name (Legal Business Name): EDWIN N CARTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

8348 TRAFORD LANE SUITE 102
SPRINGFIELD VA
22152
US

IV. Provider business mailing address

8348 TRAFORD LANE SUITE 102
SPRINGFIELD VA
22152
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax: 703-569-7248
Mailing address:
  • Phone: 703-569-8731
  • Fax: 703-569-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: