Provider Demographics
NPI:1376841791
Name:CARTER, CHARLES E (LADAC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:CARTER
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 GOLF COURSE RD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1762
Mailing Address - Country:US
Mailing Address - Phone:505-994-4100
Mailing Address - Fax:505-994-1229
Practice Address - Street 1:1603 GOLF COURSE RD SE
Practice Address - Street 2:SUITE A
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1762
Practice Address - Country:US
Practice Address - Phone:505-994-4100
Practice Address - Fax:505-994-1229
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3701101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)