MEDICARE: MRS. CARIE NIELSON CARTER L.C.S.W

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		VA

General Provider Information

NPI Number	:	1104996180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARIE NIELSON CARTER L.C.S.W

Provider Business Mailing Address
First Line	:	4410 CHRISTIANSBURG PIKE NE
Second Line	:
City	:	PILOT
State	:	VA
Zip	:	24138
Country	:	US
Telephone Number	:	540-745-3887
Fax Number	:	540-745-7188

Provider Business Practice Location Address
First Line	:	4410 CHRISTIANSBURG PIKE NE
Second Line	:
City	:	PILOT
State	:	VA
Zip	:	24138
Country	:	US
Telephone Number	:	540-745-3887
Fax Number	:	540-745-7188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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