Provider Demographics
NPI:1366974883
Name:CARTER, JESSICA NICOLE (LMFTA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 MARSHLANE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-671-3967
Mailing Address - Fax:
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:#220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:919-781-2266
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12016A106H00000X
NC07366225700000X
NCA12911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional