Provider Demographics
NPI:1699215640
Name:CARTER, MICHAEL O SR (LSW, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:O
Last Name:CARTER
Suffix:SR
Gender:M
Credentials:LSW, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 MILLRACE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4621
Mailing Address - Country:US
Mailing Address - Phone:614-397-6722
Mailing Address - Fax:
Practice Address - Street 1:1409 E LIVINGSTON AVE
Practice Address - Street 2:2743 MILLRACE DRIVE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2926
Practice Address - Country:US
Practice Address - Phone:614-253-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0800629104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker