MEDICARE: DANA M CARTER MSW/LCSW

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	2002030044	MO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2002030044	MO
3	101YM0800X	Mental Health Counselor	2002030044	MO
4	1041S0200X	School Social Worker	2002030044	MO

General Provider Information

NPI Number	:	1194779868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA M CARTER MSW/LCSW

Provider Business Mailing Address
First Line	:	19 E WALNUT ST
Second Line	:	SUITE G
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4505
Country	:	US
Telephone Number	:	573-356-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E WALNUT ST
Second Line	:	SUITE G
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4505
Country	:	US
Telephone Number	:	573-356-8111
Fax Number	:	573-634-4010

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/16/2007

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