Provider Demographics
NPI:1750605911
Name:CARTER, DARNETTA D (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:MS
First Name:DARNETTA
Middle Name:D
Last Name:CARTER
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 CORPORATE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2928
Mailing Address - Country:US
Mailing Address - Phone:314-591-9918
Mailing Address - Fax:
Practice Address - Street 1:1033 CORPORATE SQUARE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2928
Practice Address - Country:US
Practice Address - Phone:314-591-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2013-05-06
Deactivation Date:2012-03-27
Deactivation Code:
Reactivation Date:2013-05-06
Provider Licenses
StateLicense IDTaxonomies
MO2006022574101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 1041S0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist