Provider Demographics
NPI:1629199955
Name:CARTER, SHANTERRA REGINA (BA)
Entity Type:Individual
Prefix:MS
First Name:SHANTERRA
Middle Name:REGINA
Last Name:CARTER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1929
Mailing Address - Country:US
Mailing Address - Phone:727-639-6579
Mailing Address - Fax:727-822-1030
Practice Address - Street 1:5949 38TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1929
Practice Address - Country:US
Practice Address - Phone:727-639-6579
Practice Address - Fax:727-822-1030
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker