Provider Demographics
NPI:1992340392
Name:CARTER, JESSICA (CRC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 GA HIGHWAY 135
Mailing Address - Street 2:
Mailing Address - City:NAYLOR
Mailing Address - State:GA
Mailing Address - Zip Code:31641-2065
Mailing Address - Country:US
Mailing Address - Phone:229-460-5401
Mailing Address - Fax:
Practice Address - Street 1:9070 GA HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:NAYLOR
Practice Address - State:GA
Practice Address - Zip Code:31641-2065
Practice Address - Country:US
Practice Address - Phone:229-460-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor