Provider Demographics
NPI:1497985287
Name:CARTER, TAMIKA JANELLE (LADC-MH, LAADC, CCDP)
Entity Type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:JANELLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LADC-MH, LAADC, CCDP
Other - Prefix:MISS
Other - First Name:TAMIKA
Other - Middle Name:JANELLE
Other - Last Name:GAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHRS, BHCM
Mailing Address - Street 1:14726 RAMONA AVE # E4
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:909-255-9135
Mailing Address - Fax:
Practice Address - Street 1:17595 ALMAHURST ST
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1779
Practice Address - Country:US
Practice Address - Phone:626-344-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 106S00000X, 101YM0800X
CA101YS0200X
OK101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200386690AMedicaid