Provider Demographics
NPI:1811661630
Name:MCCARTER, LATRICE RENE (RBT)
Entity type:Individual
Prefix:
First Name:LATRICE
Middle Name:RENE
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:LATRICE
Other - Middle Name:RENE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 FAIRFAX PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5324
Mailing Address - Country:US
Mailing Address - Phone:912-409-5132
Mailing Address - Fax:
Practice Address - Street 1:701 FAIRFAX PL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5324
Practice Address - Country:US
Practice Address - Phone:912-409-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GARBT-21-177571106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician