Provider Demographics
NPI:1750491031
Name:CARTER, CAROLE JANICE (MS LCPC LMFT NCC)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:JANICE
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS LCPC LMFT NCC
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:JANICE
Other - Last Name:CARTER KERSBERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LCPC NCC
Mailing Address - Street 1:1674 HILL ROAD
Mailing Address - Street 2:STE 12 CARTER COUNSELING
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-344-4992
Mailing Address - Fax:208-344-4622
Practice Address - Street 1:1674 HILL ROAD
Practice Address - Street 2:STE 12 CARTER COUNSELING
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-344-4992
Practice Address - Fax:208-344-4622
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC377103T00000X
IDLMFT2719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ4939OtherBLUE CROSS OF ID
ID000010144532OtherREGENCE BLUE SHIELD