Provider Demographics
NPI:1619368016
Name:CARTER, WAYNE D (CERTIFIED COUNSELOR)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:CARTER
Suffix:
Gender:M
Credentials:CERTIFIED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 S 38TH ST
Mailing Address - Street 2:PMB 163
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7303
Mailing Address - Country:US
Mailing Address - Phone:253-310-2667
Mailing Address - Fax:
Practice Address - Street 1:240 S STADIUM WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4802
Practice Address - Country:US
Practice Address - Phone:253-310-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60160531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health