Provider Demographics
NPI:1629359021
Name:CARTER, DELESTE DIONNE (MED, BSW)
Entity type:Individual
Prefix:MRS
First Name:DELESTE
Middle Name:DIONNE
Last Name:CARTER
Suffix:
Gender:F
Credentials:MED, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 TYLER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-6306
Mailing Address - Country:US
Mailing Address - Phone:706-664-8238
Mailing Address - Fax:
Practice Address - Street 1:826 TYLER WOODS DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-6306
Practice Address - Country:US
Practice Address - Phone:706-664-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor