Provider Demographics
NPI:1982211520
Name:CARTER, ELIJAH LEE (CRC, CVE, LPC, CDMS)
Entity Type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:LEE
Last Name:CARTER
Suffix:
Gender:M
Credentials:CRC, CVE, LPC, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 GARDNERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3792
Mailing Address - Country:US
Mailing Address - Phone:706-339-8188
Mailing Address - Fax:
Practice Address - Street 1:3001 GORDON HWY
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3808
Practice Address - Country:US
Practice Address - Phone:706-855-4883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00116768225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor