Provider Demographics
NPI:1699098020
Name:CARTER, CINTOYA BERNETT (LPC005625)
Entity type:Individual
Prefix:
First Name:CINTOYA
Middle Name:BERNETT
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC005625
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0895
Mailing Address - Country:US
Mailing Address - Phone:678-523-6077
Mailing Address - Fax:
Practice Address - Street 1:3521 CLARE COTTAGE TRCE SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-6084
Practice Address - Country:US
Practice Address - Phone:678-523-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional