Provider Demographics
NPI:1710453345
Name:CARTER, SHALONDA N
Entity Type:Individual
Prefix:
First Name:SHALONDA
Middle Name:N
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WESTPOINTE CT APT B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6944
Mailing Address - Country:US
Mailing Address - Phone:803-743-6396
Mailing Address - Fax:
Practice Address - Street 1:119 WESTPOINTE CT APT B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6944
Practice Address - Country:US
Practice Address - Phone:803-743-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician