Provider Demographics
NPI:1326771684
Name:CARTER, SHELLI (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 VISTA PACIFICA UNIT 11
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4832
Mailing Address - Country:US
Mailing Address - Phone:713-924-7728
Mailing Address - Fax:
Practice Address - Street 1:63 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1623
Practice Address - Country:US
Practice Address - Phone:713-924-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00589500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional