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NPI Code Detail

MEDICARE: MICHAEL O CARTER SR. LSW, LICDC-CS

MEDICARE: MICHAEL O CARTER SR. LSW, LICDC-CS
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
1104100000XSocial WorkerS0800629OH

General Provider Information

NPI Number : 1699215640
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL O CARTER SR. LSW, LICDC-CS
Provider Business Mailing Address
First Line : 2743 MILLRACE DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-4621
Country : US
Telephone Number : 614-397-6722
Fax Number :
Provider Business Practice Location Address
First Line : 1409 E LIVINGSTON AVE
Second Line : 2743 MILLRACE DRIVE
City : COLUMBUS
State : OH
Zip : 43205-2926
Country : US
Telephone Number : 614-253-4448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2017
Last Update Date : 02/24/2017

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Directions to “ MICHAEL O CARTER SR. LSW, LICDC-CS” Practice Location

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