Provider Demographics
NPI:1356546964
Name:CARTER, THOMAS DARRELL (M ED)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DARRELL
Last Name:CARTER
Suffix:
Gender:M
Credentials:M ED
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 871
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-0871
Mailing Address - Country:US
Mailing Address - Phone:434-476-8888
Mailing Address - Fax:434-476-8889
Practice Address - Street 1:523 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1114
Practice Address - Country:US
Practice Address - Phone:336-722-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC464101YA0400X
NC2046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional