Provider Demographics
NPI:1417220492
Name:CARTER, NICOLE C (LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SUTTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-1150
Mailing Address - Country:US
Mailing Address - Phone:510-366-3782
Mailing Address - Fax:888-234-7416
Practice Address - Street 1:1320 SUTTERVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-1150
Practice Address - Country:US
Practice Address - Phone:510-366-3782
Practice Address - Fax:888-234-7416
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32774104100000X
CA74599104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker