MEDICARE: MRS. CRISOL ALEXANDRIA CARTER

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	C017816	NC
2	106S00000X	Behavior Technician
3	1041C0700X	Clinical Social Worker	121411	CA

General Provider Information

NPI Number	:	1164926663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRISOL ALEXANDRIA CARTER

Provider Business Mailing Address
First Line	:	125 LEO DR
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1739
Country	:	US
Telephone Number	:	661-794-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 GLENWOOD DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93306-4230
Country	:	US
Telephone Number	:	661-794-8657
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	06/10/2025

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