Provider Demographics
NPI:1992358410
Name:MAZZA CARTER, KRISTA ANN (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:MAZZA CARTER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:1152 CAHAL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1610
Mailing Address - Country:US
Mailing Address - Phone:678-502-0411
Mailing Address - Fax:
Practice Address - Street 1:1152 CAHAL AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-1610
Practice Address - Country:US
Practice Address - Phone:678-502-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3289101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional