Provider Demographics
NPI:1356620991
Name:CARTER, LATONYA ANN
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:ANN
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 1:834 SAINT CATHERINES DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6639
Mailing Address - Country:US
Mailing Address - Phone:252-767-7561
Mailing Address - Fax:919-554-9670
Practice Address - Street 1:834 SAINT CATHERINES DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6639
Practice Address - Country:US
Practice Address - Phone:252-767-7561
Practice Address - Fax:919-554-9670
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303124Medicaid