Provider Demographics
NPI:1871083196
Name:CARTER, JESSICA N (ACSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:CARTER
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S SHEPHERD ST STE D
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5076
Mailing Address - Country:US
Mailing Address - Phone:209-454-5904
Mailing Address - Fax:
Practice Address - Street 1:230 S SHEPHERD ST STE D
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5076
Practice Address - Country:US
Practice Address - Phone:209-454-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81400101Y00000X
CAASW814001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor