Provider Demographics
NPI:1679014310
Name:CARTER, JEFFREY PATRICK (CDP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PATRICK
Last Name:CARTER
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 E SPRAGUE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8544
Mailing Address - Country:US
Mailing Address - Phone:509-475-9768
Mailing Address - Fax:
Practice Address - Street 1:812 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3326
Practice Address - Country:US
Practice Address - Phone:509-475-9768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60644091OtherDOH