Provider Demographics
NPI:1477713659
Name:CARTER, CHANTAL AIMEE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:AIMEE
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 1:2592 N GREGG AVE, SUITE 10
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2894
Mailing Address - Country:US
Mailing Address - Phone:479-790-2324
Mailing Address - Fax:888-965-6911
Practice Address - Street 1:2592 N GREGG AVE STE 10
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5520
Practice Address - Country:US
Practice Address - Phone:479-790-2324
Practice Address - Fax:888-965-6911
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2292-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical