1114468105 NPI number — CHELSEA CARTER LICSW

Table of content: CHELSEA CARTER LICSW (NPI 1114468105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114468105 NPI number — CHELSEA CARTER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTER
Provider First Name:
CHELSEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1114468105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25303-0413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
681-208-3750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825A BIGLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25302-4145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-928-5144
Provider Business Practice Location Address Fax Number:
304-929-1290
Provider Enumeration Date:
03/10/2017

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:  DP00945150 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1902407034 . This is a "LOTUS NPI NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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