Provider Demographics
NPI:1013105329
Name:DAVID CARTER, PSY.D., PLLC
Entity Type:Organization
Organization Name:DAVID CARTER, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-629-1000
Mailing Address - Street 1:1133 LOUISIANA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1133 LOUISIANA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2350
Practice Address - Country:US
Practice Address - Phone:407-629-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5836103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54408OtherBC/BS OF FLORIDA
FL54408OtherBC/BS OF FLORIDA