Provider Demographics
NPI:1336492172
Name:CARTER, CASSANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 F STREET SUITE 3 PMB811
Mailing Address - Street 2:SUITE 3 #811
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-267-7974
Mailing Address - Fax:
Practice Address - Street 1:600 F STREET SUITE 3 PMB811
Practice Address - Street 2:SUITE 3 #811
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-267-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL151151041C0700X
CA707291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical