Provider Demographics
NPI:1194980532
Name:CARTER, VIVIAN SMITH (MS)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:SMITH
Last Name:CARTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:VIVIAN
Other - Middle Name:YNETTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2211 BESSEMER RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-4711
Mailing Address - Country:US
Mailing Address - Phone:205-937-4490
Mailing Address - Fax:205-776-8300
Practice Address - Street 1:2107 5TH AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3375
Practice Address - Country:US
Practice Address - Phone:205-937-2291
Practice Address - Fax:205-327-3736
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist