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General NPI Number Information
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NPI Number | 1982211520
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Entity Type | Individual
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Provider Name | ELIJAH LEE CARTER CRC, CVE, LPC, CDMS
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Gender | Male
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 3001 GORDON HWY
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City | GROVETOWN
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State | GA
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Zip | 30813-3808
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Country | US
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Telephone | 706-855-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 144 GARDNERS MILL RD
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City | AUGUSTA
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State | GA
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Zip | 30907-3792
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Country | US
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Telephone | 706-339-8188
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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 | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00116768
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License Number State |
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