Provider Demographics
NPI:1033511472
Name:CARTER, KRYSTAL (LPC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:LAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3905 FORD RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2824
Mailing Address - Country:US
Mailing Address - Phone:215-220-2111
Mailing Address - Fax:
Practice Address - Street 1:3905 FORD RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2824
Practice Address - Country:US
Practice Address - Phone:215-220-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional