Healthcare Provider Details

I. General information

NPI: 1164933271
Provider Name (Legal Business Name): LOU ANN R. CARTER MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 16TH STREET
EVERETT WA
98201
US

IV. Provider business mailing address

P.O. BOX 1906
MARYSVILLE WA
98270
US

V. Phone/Fax

Practice location:
  • Phone: 360-722-1471
  • Fax:
Mailing address:
  • Phone: 360-722-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMC60778339
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW60431473
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: