Provider Demographics
NPI:1124477203
Name:CARTER, KENESHA
Entity type:Individual
Prefix:
First Name:KENESHA
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 1:3533 RIO ROBLES DR
Mailing Address - Street 2:APT A
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-0082
Mailing Address - Country:US
Mailing Address - Phone:323-637-7990
Mailing Address - Fax:
Practice Address - Street 1:3533 RIO ROBLES DR
Practice Address - Street 2:APT A
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-0082
Practice Address - Country:US
Practice Address - Phone:323-637-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst