MEDICARE: DAJENAE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO61198089	WA
2	171M00000X	Case Manager/Care Coordinator	CG60639707	WA

General Provider Information

NPI Number	:	1407328099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAJENAE CARTER

Provider Business Mailing Address
First Line	:	1355 S PEARL ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-2337
Country	:	US
Telephone Number	:	206-326-9824
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 S LANE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2829
Country	:	US
Telephone Number	:	206-643-7926
Fax Number	:

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

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	09/08/2021

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