Provider Demographics
NPI:1013890987
Name:CARTER, CHARLENE (PPS-210070728)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PPS-210070728
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-7256
Mailing Address - Country:US
Mailing Address - Phone:760-247-8001
Mailing Address - Fax:
Practice Address - Street 1:19445 SITTING BULL RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5002
Practice Address - Country:US
Practice Address - Phone:760-961-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210070728101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool