1477713659 NPI number — CHANTAL AIMEE CARTER LCSW

Table of content: CHANTAL AIMEE CARTER LCSW (NPI 1477713659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477713659 NPI number — CHANTAL AIMEE CARTER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
CHANTAL
Provider Middle Name:
AIMEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477713659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2592 N GREGG AVE, SUITE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-2894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-790-2324
Provider Business Mailing Address Fax Number:
888-965-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2592 N GREGG AVE STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-5520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-790-2324
Provider Business Practice Location Address Fax Number:
888-965-6911
Provider Enumeration Date:
06/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2292-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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