Provider Demographics
NPI:1952034779
Name:CARTER, ANDREA M (LDCDII)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:LDCDII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2676
Mailing Address - Country:US
Mailing Address - Phone:937-717-5843
Mailing Address - Fax:
Practice Address - Street 1:2131 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2676
Practice Address - Country:US
Practice Address - Phone:937-717-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161337101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)