Provider Demographics
NPI:1962381210
Name:CARTER, VICKY (LSW)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 W ARQUILLA DR APT 334
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1147
Mailing Address - Country:US
Mailing Address - Phone:708-252-4145
Mailing Address - Fax:
Practice Address - Street 1:18161 MORRIS AVE STE 207
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2141
Practice Address - Country:US
Practice Address - Phone:708-252-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.107747101Y00000X, 101YP1600X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral