Healthcare Provider Details

I. General information

NPI: 1154196277
Provider Name (Legal Business Name): CARNATION AND ARROW THERAPEUTIC SERVICES, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 36TH ST
BALTIMORE MD
21211-2537
US

IV. Provider business mailing address

800 W 36TH ST
BALTIMORE MD
21211-2537
US

V. Phone/Fax

Practice location:
  • Phone: 240-593-9096
  • Fax:
Mailing address:
  • Phone: 443-540-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARLEY KELCEE AGUEDA-DIVENS
Title or Position: OWNER
Credential: LCSW-C
Phone: 443-540-8280