=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477510253
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA LORRAINE CARTER L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 973 ENOTA AVE NE
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-532-9596
-----------------------------------------------------
Fax | 770-205-3218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 SMALL POND DR
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30528-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-865-2716
-----------------------------------------------------
Fax | 706-348-1952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2101
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------