Provider Demographics
NPI:1972954576
Name:CARTER, JOANNA (MED, CNA, MA, PRS)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:MED, CNA, MA, PRS
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 613
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-0613
Mailing Address - Country:US
Mailing Address - Phone:202-769-2032
Mailing Address - Fax:
Practice Address - Street 1:204 N MAIN ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-9416
Practice Address - Country:US
Practice Address - Phone:202-997-5738
Practice Address - Fax:804-729-3529
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0180865658171M00000X
101YM0800X, 103K00000X, 106S00000X, 175T00000X
VA0181969996171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0180865658Medicaid
VA0181969996Medicaid