Provider Demographics
NPI:1770093577
Name:CARTER, TAMMY LYNN (MA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 JAMACHA RD # 243
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019
Mailing Address - Country:US
Mailing Address - Phone:619-396-0367
Mailing Address - Fax:760-919-3132
Practice Address - Street 1:771 JAMACHA ROAD, #243
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019
Practice Address - Country:US
Practice Address - Phone:619-396-0367
Practice Address - Fax:760-919-3132
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF954436106H00000X
CA117201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457591364OtherNPI