Provider Demographics
NPI:1295473239
Name:CARTER, KRISTA K (LSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:K
Last Name:CARTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W ADAMS ST STE 514
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5108
Mailing Address - Country:US
Mailing Address - Phone:312-578-9990
Mailing Address - Fax:312-275-7663
Practice Address - Street 1:300 W ADAMS ST STE 514
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5108
Practice Address - Country:US
Practice Address - Phone:312-578-9990
Practice Address - Fax:312-275-7663
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1295473239104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty