Provider Demographics
NPI:1639416886
Name:CARTER, KRYSTAL GRACE (MS)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:GRACE
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 E EVANS ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2511
Mailing Address - Country:US
Mailing Address - Phone:843-605-5228
Mailing Address - Fax:843-679-2633
Practice Address - Street 1:181 E EVANS ST
Practice Address - Street 2:SUITE 316
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2511
Practice Address - Country:US
Practice Address - Phone:843-605-5228
Practice Address - Fax:843-679-2633
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor