Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | NO LICENSE |
NPI | 1003236894 |
---|---|
Provider Name | Starita Carter |
First Address | Edmond, OK 73013-3645 |
Second Address | Edmond, OK 73013-3645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 20/10/2014 |