Provider Demographics
NPI:1124848437
Name:CARTER, JENNIFER (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 COLE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6520
Mailing Address - Country:US
Mailing Address - Phone:760-518-6086
Mailing Address - Fax:
Practice Address - Street 1:2339 11TH ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6604
Practice Address - Country:US
Practice Address - Phone:760-456-7462
Practice Address - Fax:858-863-6936
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health