Provider Demographics
NPI:1730914664
Name:CARVER, MERCURY
Entity type:Individual
Prefix:
First Name:MERCURY
Middle Name:
Last Name:CARVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 HOLLY CREST LN APT 310
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5113
Mailing Address - Country:US
Mailing Address - Phone:910-494-1608
Mailing Address - Fax:
Practice Address - Street 1:6115 PARK SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3269
Practice Address - Country:US
Practice Address - Phone:704-285-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0212291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical