Provider Demographics
NPI:1891836136
Name:CHILDS, CARTER EVANS (RAS-C0509020847)
Entity Type:Individual
Prefix:MR
First Name:CARTER
Middle Name:EVANS
Last Name:CHILDS
Suffix:
Gender:M
Credentials:RAS-C0509020847
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92247-0355
Mailing Address - Country:US
Mailing Address - Phone:760-347-0754
Mailing Address - Fax:760-347-8507
Practice Address - Street 1:83912 AVENUE 45
Practice Address - Street 2:SUITE #9
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3338
Practice Address - Country:US
Practice Address - Phone:760-347-0754
Practice Address - Fax:760-347-8507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)