Provider Demographics
NPI:1376923029
Name:CARTER, ALICIA HARDIN (MSPSY)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:HARDIN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MSPSY
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 632
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:VA
Mailing Address - Zip Code:22503-0632
Mailing Address - Country:US
Mailing Address - Phone:757-207-0936
Mailing Address - Fax:804-642-5232
Practice Address - Street 1:8545 MARY BALL RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:VA
Practice Address - Zip Code:22503-2523
Practice Address - Country:US
Practice Address - Phone:757-207-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health