Provider Demographics
NPI:1417603077
Name:CARTER, KIERRA ALEXIS (LCMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:ALEXIS
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:MISS
Other - First Name:KIERRA
Other - Middle Name:ALEXIS
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMHCA, NCC
Mailing Address - Street 1:300 ROSEMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-5270
Mailing Address - Country:US
Mailing Address - Phone:843-319-0691
Mailing Address - Fax:
Practice Address - Street 1:163 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1836
Practice Address - Country:US
Practice Address - Phone:336-831-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7701101YM0800X
NCA17348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health