Provider Demographics
NPI:1972161230
Name:CARTER, MARVA DENISE (LPC, LICDC, SWA)
Entity type:Individual
Prefix:
First Name:MARVA
Middle Name:DENISE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC, LICDC, SWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 CORPORATE WAY STE 103100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4268
Mailing Address - Country:US
Mailing Address - Phone:937-619-9089
Mailing Address - Fax:
Practice Address - Street 1:865 S PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2624
Practice Address - Country:US
Practice Address - Phone:937-966-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305561101YP2500X
OHLICDC.162354101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty