Provider Demographics
NPI:1912743378
Name:CARBONELL, ERICA MORGAN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MORGAN
Last Name:CARBONELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NEXTON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7915
Mailing Address - Country:US
Mailing Address - Phone:843-879-8577
Mailing Address - Fax:843-594-0110
Practice Address - Street 1:700 NEXTON SQUARE DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7915
Practice Address - Country:US
Practice Address - Phone:843-879-8577
Practice Address - Fax:843-594-0110
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4812103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool