Provider Demographics
NPI:1649428673
Name:CARTER, VICKI (PSYD, LPC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WAMPANOAG TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1504
Mailing Address - Country:US
Mailing Address - Phone:401-431-9870
Mailing Address - Fax:401-437-8847
Practice Address - Street 1:6 JOHN H CHAFEE BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1034
Practice Address - Country:US
Practice Address - Phone:401-848-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2697101YP2500X
103T00000X
RIMHC01119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236338Medicaid