Provider Demographics
NPI:1134574791
Name:CARTER, SHARON RAE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:RAE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 EATON DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8228
Mailing Address - Country:US
Mailing Address - Phone:970-398-0883
Mailing Address - Fax:877-512-6720
Practice Address - Street 1:46 EATON DR STE 3
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8228
Practice Address - Country:US
Practice Address - Phone:970-398-0883
Practice Address - Fax:877-512-6720
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003828103TC0700X
TX21174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical