Provider Demographics
NPI:1457007429
Name:CARTER, CHEYANNE NICOLE
Entity Type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:NICOLE
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 1:5830 MEMORIAL HWY APT 1406
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5064
Mailing Address - Country:US
Mailing Address - Phone:614-678-9631
Mailing Address - Fax:
Practice Address - Street 1:1400 GANDY BLVD N UNIT 204
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2118
Practice Address - Country:US
Practice Address - Phone:813-324-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-203857106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician