=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285994228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN CARTER & ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2012
-----------------------------------------------------
Last Update Date | 05/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4645 NEWCOM AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-588-8667
-----------------------------------------------------
Fax | 865-483-5562
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4645 NEWCOM AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-588-8667
-----------------------------------------------------
Fax | 865-483-5562
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SUSAN F. CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-588-8667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW3056
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------