Provider Demographics
NPI:1295167591
Name:CARTER, JOEL LYNN (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E SHAW AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7619
Mailing Address - Country:US
Mailing Address - Phone:559-225-6100
Mailing Address - Fax:559-224-3873
Practice Address - Street 1:155 E SHAW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7619
Practice Address - Country:US
Practice Address - Phone:559-225-6100
Practice Address - Fax:559-224-3873
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP039396781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical