Provider Demographics
NPI:1487224770
Name:CARTER, JENNETTA MINYON (MBA LCDC)
Entity Type:Individual
Prefix:
First Name:JENNETTA
Middle Name:MINYON
Last Name:CARTER
Suffix:
Gender:F
Credentials:MBA LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11151 CANYON TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-3917
Mailing Address - Country:US
Mailing Address - Phone:281-709-8970
Mailing Address - Fax:
Practice Address - Street 1:6315 GULFTON ST STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:713-457-0945
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10209101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)