Provider Demographics
NPI:1124545801
Name:CARTER, ILONA KALIAAKEAO
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:KALIAAKEAO
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 S JONES BLVD STE D3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3370
Mailing Address - Country:US
Mailing Address - Phone:702-991-3150
Mailing Address - Fax:
Practice Address - Street 1:4425 S JONES BLVD STE D3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3370
Practice Address - Country:US
Practice Address - Phone:702-991-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104100000XMedicaid