Provider Demographics
NPI:1689092173
Name:CARTER, CAROLYN PEARSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:PEARSON
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 AMKEY WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5168
Mailing Address - Country:US
Mailing Address - Phone:317-435-3644
Mailing Address - Fax:
Practice Address - Street 1:921 E 86TH ST STE 210B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1841
Practice Address - Country:US
Practice Address - Phone:317-325-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6136103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical