Provider Demographics
NPI:1114245594
Name:CARTER, TERESSA DANA-IONE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:TERESSA
Middle Name:DANA-IONE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESSA
Other - Middle Name:DANA-IONE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3515 ARISTA BLVD APT 9212
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1269
Mailing Address - Country:US
Mailing Address - Phone:910-787-2248
Mailing Address - Fax:910-353-1536
Practice Address - Street 1:3515 ARISTA BLVD UNIT 9212U
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1196
Practice Address - Country:US
Practice Address - Phone:910-787-2248
Practice Address - Fax:910-353-1536
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3486-C1041C0700X
RIISW030381041C0700X
TX669501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical