Provider Demographics
NPI:1134695950
Name:CARTER, HEATHER (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 CRUMPLER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1907
Mailing Address - Country:US
Mailing Address - Phone:731-577-1916
Mailing Address - Fax:
Practice Address - Street 1:6915 CRUMPLER BLVD STE A
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1907
Practice Address - Country:US
Practice Address - Phone:731-577-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0196101YP2500X
MS2368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional