Provider Demographics
NPI:1548933328
Name:CARTER, DAWN ELIZABETH
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ELIZABETH
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:ELIZABETH
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:6714 HUMBOLDT AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2241
Mailing Address - Country:US
Mailing Address - Phone:180-623-6457
Mailing Address - Fax:
Practice Address - Street 1:2217 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3382
Practice Address - Country:US
Practice Address - Phone:612-767-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305772101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)