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General NPI Number Information
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NPI Number | 1871083196
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Entity Type | Individual
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Provider Name | JESSICA N CARTER ACSW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 12/07/2019
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Provider Practice Location Address
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Address Line | 230 S SHEPHERD ST STE D
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City | SONORA
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State | CA
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Zip | 95370-5076
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Country | US
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Telephone | 209-454-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 230 S SHEPHERD ST STE D
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City | SONORA
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State | CA
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Zip | 95370-5076
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Country | US
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Telephone | 209-454-5904
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 81400
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW81400
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License Number State | CA
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