Healthcare Provider Details

I. General information

NPI: 1114468105
Provider Name (Legal Business Name): CHELSEA CARTER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825A BIGLEY AVE
CHARLESTON WV
25302-4145
US

IV. Provider business mailing address

PO BOX 8413
SOUTH CHARLESTON WV
25303-0413
US

V. Phone/Fax

Practice location:
  • Phone: 304-928-5144
  • Fax: 304-929-1290
Mailing address:
  • Phone: 681-208-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00945150
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: