Provider Demographics
NPI:1912674615
Name:CARTER, INDONESIA
Entity Type:Individual
Prefix:
First Name:INDONESIA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 GAMBRILLS RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1141
Mailing Address - Country:US
Mailing Address - Phone:443-569-8882
Mailing Address - Fax:
Practice Address - Street 1:331 GAMBRILLS RD STE 4B
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1141
Practice Address - Country:US
Practice Address - Phone:443-569-8882
Practice Address - Fax:410-697-3436
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker