Provider Demographics
NPI:1982342549
Name:CARTER, KAITLIN ANN (LPC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5116
Mailing Address - Country:US
Mailing Address - Phone:540-449-5277
Mailing Address - Fax:
Practice Address - Street 1:707 5TH ST NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-2123
Practice Address - Country:US
Practice Address - Phone:540-966-5808
Practice Address - Fax:540-966-5811
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011386101YM0800X, 101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)