Provider Demographics
NPI:1669929378
Name:MOODY-CARTER, GRANETTA MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:GRANETTA
Middle Name:MARIE
Last Name:MOODY-CARTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WHITNEY AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2503
Mailing Address - Country:US
Mailing Address - Phone:504-362-9010
Mailing Address - Fax:
Practice Address - Street 1:401 WHITNEY AVE STE 401
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2503
Practice Address - Country:US
Practice Address - Phone:504-362-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12528171M00000X
LA12528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator