Provider Demographics
NPI:1760492060
Name:CARTER, SHELLEY NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:NICOLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:NICOLE
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 E HOSPITAL RD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-8650
Mailing Address - Fax:706-787-8652
Practice Address - Street 1:300 E HOSPITAL RD
Practice Address - Street 2:BLDG 300
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-8650
Practice Address - Fax:706-787-8652
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0039811041C0700X
IN3400514A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical