Provider Demographics
NPI:1295994788
Name:CARTER, KIMBERLY E (LPA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32044
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2044
Mailing Address - Country:US
Mailing Address - Phone:828-262-3000
Mailing Address - Fax:
Practice Address - Street 1:614 HOWARD ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6244
Practice Address - Country:US
Practice Address - Phone:828-262-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107566Medicaid