Carter, Tavis

Carter, Tavis is an individual health care provider with primary practice located at 530 N Main St , Providence RI 02904-5762. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Carter, Tavis can be contacted via phone (401) 274-2500.

Contact Information

Primary practice address
530 N Main St Providence RI 02904-5762
Phone: (401) 274-2500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LCDP00206 Rhode Island

Profile Details

NPI number 1700071701
LBN Legal business name Carter, Tavis
Credentials LCDP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 12th, 2007
Last updated Mar 27th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700071701 NPPES
Rhode Island MEDICAID TC68351
Rhode Island Other 1104847946

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