Provider Demographics
NPI:1841783354
Name:CARTER, CHRISTOPHER DESHAY
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DESHAY
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 LANGHORNE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1600
Mailing Address - Country:US
Mailing Address - Phone:434-386-8199
Mailing Address - Fax:
Practice Address - Street 1:2616 LANGHORNE RD STE 1
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1600
Practice Address - Country:US
Practice Address - Phone:434-386-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2864-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health