Provider Demographics
NPI:1295351435
Name:CARTER, CHAQUANA RENEE'
Entity type:Individual
Prefix:
First Name:CHAQUANA
Middle Name:RENEE'
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 1:119 RIDGEBEND DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1601
Mailing Address - Country:US
Mailing Address - Phone:706-474-3948
Mailing Address - Fax:
Practice Address - Street 1:119 RIDGEBEND DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1601
Practice Address - Country:US
Practice Address - Phone:706-474-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker