Provider Demographics
NPI:1750085841
Name:CARTER, SPENCER (BA CSC)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:BA CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 CHAFFEE POINT BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-4131
Mailing Address - Country:US
Mailing Address - Phone:904-701-0317
Mailing Address - Fax:
Practice Address - Street 1:514 CHAFFEE POINT BLVD STE 11
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-4131
Practice Address - Country:US
Practice Address - Phone:904-701-0317
Practice Address - Fax:904-736-7546
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health