Provider Demographics
NPI:1992399042
Name:CARTER CLINIC, P.A.
Entity Type:Organization
Organization Name:CARTER CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYLEME
Authorized Official - Middle Name:OJINGA
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-848-0132
Mailing Address - Street 1:PO BOX 99778
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27624-9778
Mailing Address - Country:US
Mailing Address - Phone:919-423-0267
Mailing Address - Fax:
Practice Address - Street 1:703 W 3RD AVE BLDG B
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1524
Practice Address - Country:US
Practice Address - Phone:910-491-2352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children