Provider Demographics
NPI:1356134464
Name:CARTER, SHAVON MICHELLE
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:MICHELLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10556 SALLY RIDE LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2590
Mailing Address - Country:US
Mailing Address - Phone:301-957-8021
Mailing Address - Fax:
Practice Address - Street 1:10556 SALLY RIDE LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2590
Practice Address - Country:US
Practice Address - Phone:301-957-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health