MEDICARE: MRS. SAMANTHA CARTER ALC

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	101YM0800X	Mental Health Counselor	3233	AL

General Provider Information

NPI Number	:	1487391884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA CARTER ALC

Provider Business Mailing Address
First Line	:	402 OFFICE PARK DR STE 250C
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-675-0630
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 OFFICE PARK DR STE 250C
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-675-0630
Fax Number	:

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

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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