Provider Demographics
NPI:1932739893
Name:MCCARTER, KRISTEN LEAH
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEAH
Last Name:MCCARTER
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 1:316 MID VALLEY CTR STE 186
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8516
Mailing Address - Country:US
Mailing Address - Phone:800-991-6071
Mailing Address - Fax:800-991-6071
Practice Address - Street 1:108 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8771
Practice Address - Country:US
Practice Address - Phone:864-473-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-19-98202106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician