Provider Demographics
NPI:1932597317
Name:CARTER, CHRISTINE SAUTHOFF (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SAUTHOFF
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177-1377
Mailing Address - Country:US
Mailing Address - Phone:813-812-0323
Mailing Address - Fax:
Practice Address - Street 1:212 WINGATE PL SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:813-812-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12691235Z00000X
NY0096071235Z00000X
VA2202004584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist