Provider Demographics
NPI:1356996284
Name:CARTER, CREE L
Entity type:Individual
Prefix:
First Name:CREE
Middle Name:L
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 1:2671 SHERIDAN RD APT 301
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2684
Mailing Address - Country:US
Mailing Address - Phone:256-457-4039
Mailing Address - Fax:
Practice Address - Street 1:1800 NATIONS DR STE 116
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9171
Practice Address - Country:US
Practice Address - Phone:847-245-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health