Provider Demographics
NPI:1063956076
Name:CARTER, MIYOKIA
Entity type:Individual
Prefix:
First Name:MIYOKIA
Middle Name:
Last Name:CARTER
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 1:114 PALM VILLA
Mailing Address - Street 2:APT1
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4200
Mailing Address - Country:US
Mailing Address - Phone:985-232-8449
Mailing Address - Fax:
Practice Address - Street 1:114 PALM VILLA
Practice Address - Street 2:APT1
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4200
Practice Address - Country:US
Practice Address - Phone:985-232-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7296101YM0800X, 101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool