Provider Demographics
NPI:1447402490
Name:CARTER, DAVID E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:CARTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 NW GRANT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4366
Mailing Address - Country:US
Mailing Address - Phone:541-224-6553
Mailing Address - Fax:541-758-2277
Practice Address - Street 1:2065 NW GRANT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4366
Practice Address - Country:US
Practice Address - Phone:541-224-6553
Practice Address - Fax:541-758-2277
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106H00000X
ORL46951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist