Provider Demographics
NPI:1740346402
Name:CARTER, JEANACE (MED)
Entity type:Individual
Prefix:MRS
First Name:JEANACE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:JEANACE
Other - Middle Name:I
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:3810 WINCHESTER RD
Mailing Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6045
Mailing Address - Country:US
Mailing Address - Phone:901-369-1420
Mailing Address - Fax:901-369-1433
Practice Address - Street 1:3810 WINCHESTER RD
Practice Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6045
Practice Address - Country:US
Practice Address - Phone:901-369-1420
Practice Address - Fax:901-369-1433
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health