Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 00173-C | NV |
NPI | 1003319856 |
---|---|
Provider Name | Mr. Anthony J Carter |
First Address | Las Vegas, NV 89129-6021 |
Second Address | Las Vegas, NV 89146-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 16/03/2018 |