Provider Demographics
NPI:1619643400
Name:CARTER, NYCOLE C (BSW, LSW)
Entity Type:Individual
Prefix:
First Name:NYCOLE
Middle Name:C
Last Name:CARTER
Suffix:
Gender:F
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1631
Mailing Address - Country:US
Mailing Address - Phone:937-644-9192
Mailing Address - Fax:937-644-3426
Practice Address - Street 1:3645 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7752
Practice Address - Country:US
Practice Address - Phone:614-457-7876
Practice Address - Fax:614-457-7896
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.21067961041S0200X, 1041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician