Provider Demographics
NPI:1376043604
Name:CARTER, ELIZABETH GRAY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRAY
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 1:659 AUBURN AVE NE APT 228
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1980
Mailing Address - Country:US
Mailing Address - Phone:678-613-7288
Mailing Address - Fax:
Practice Address - Street 1:659 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5412
Practice Address - Country:US
Practice Address - Phone:678-613-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006178101YM0800X
GALPC012223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC012223OtherLPC LICENSE NUMBER