Healthcare Provider Details

I. General information

NPI: 1568258697
Provider Name (Legal Business Name): CONLEY MAURICE CARTER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7006
US

IV. Provider business mailing address

1690 OLD BRIDGE RD STE 210
WOODBRIDGE VA
22192-8006
US

V. Phone/Fax

Practice location:
  • Phone: 202-450-5822
  • Fax:
Mailing address:
  • Phone: 202-967-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00859400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200001923
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: