Provider Demographics
NPI:1720817802
Name:CARTER, CARLEY
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:CARTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:
Other - Last Name:CIOFFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 BROWN ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9608
Practice Address - Country:US
Practice Address - Phone:304-673-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist