Provider Demographics
NPI:1184058893
Name:CARTER, REVA E (LCSW)
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4686 BRISTOL TRACE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6947
Mailing Address - Country:US
Mailing Address - Phone:214-564-7722
Mailing Address - Fax:214-372-4014
Practice Address - Street 1:6923 TRAILCREST PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-3554
Practice Address - Country:US
Practice Address - Phone:214-564-7722
Practice Address - Fax:214-372-4014
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical