Provider Demographics
NPI:1407994759
Name:CARTER-FORD, LILLIE
Entity Type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:
Last Name:CARTER-FORD
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 1:988 ASHTON COVE TER
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6126
Mailing Address - Country:US
Mailing Address - Phone:904-612-4791
Mailing Address - Fax:904-641-6529
Practice Address - Street 1:3333 W 20TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-1703
Practice Address - Country:US
Practice Address - Phone:904-945-3511
Practice Address - Fax:904-493-4468
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker