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General NPI Number Information
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NPI Number | 1508498734
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Entity Type | Organization
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Legal Business Name | CARTER COLLABORATIVE COUNSELING
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6915 CRUMPLER BLVD STE A
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1907
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Country | US
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Telephone | 731-577-1916
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Fax |
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Provider Business Mailing Address
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Address Line | 6915 CRUMPLER BLVD STE A
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | HEATHER CARTER
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Credential | LPC-S
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Telephone | 731-577-1916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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