Provider Demographics
NPI:1275109357
Name:CARTER, ELLEN MINA (MSW, LCSW,CADC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MINA
Last Name:CARTER
Suffix:
Gender:F
Credentials:MSW, LCSW,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-0229
Mailing Address - Country:US
Mailing Address - Phone:717-424-1963
Mailing Address - Fax:
Practice Address - Street 1:308 S YORK ST
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-0229
Practice Address - Country:US
Practice Address - Phone:717-424-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical