Provider Demographics
NPI:1255082533
Name:CARTER, MARTHINA RENAE (ALC)
Entity type:Individual
Prefix:MS
First Name:MARTHINA
Middle Name:RENAE
Last Name:CARTER
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 MANNINGHAM LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3845
Mailing Address - Country:US
Mailing Address - Phone:334-440-2482
Mailing Address - Fax:
Practice Address - Street 1:436 MANNINGHAM LOOP
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3845
Practice Address - Country:US
Practice Address - Phone:334-440-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3951A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor