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General NPI Number Information
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NPI Number | 1184058893
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Entity Type | Individual
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Provider Name | REVA E CARTER LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 6923 TRAILCREST PL
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City | DALLAS
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State | TX
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Zip | 75232-3554
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Country | US
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Telephone | 214-564-7722
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Fax | 214-372-4014
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Provider Business Mailing Address
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Address Line | 4686 BRISTOL TRACE TRL
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City | FORT WORTH
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State | TX
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Zip | 76244-6947
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Country | US
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Telephone | 214-564-7722
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Fax | 214-372-4014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28337
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License Number State | TX
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