Provider Demographics
NPI:1184336448
Name:CARTER, JUSTINE B
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:B
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7428 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8346
Mailing Address - Country:US
Mailing Address - Phone:208-713-5772
Mailing Address - Fax:
Practice Address - Street 1:921 S ORCHARD ST STE G
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1992
Practice Address - Country:US
Practice Address - Phone:208-908-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician