Healthcare Provider Details

I. General information

NPI: 1063952349
Provider Name (Legal Business Name): CARROLL HOLMES CSC/AD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GARRISON BLVD
BALTIMORE MD
21216-2335
US

IV. Provider business mailing address

2300 GARRISON BLVD
BALTIMORE MD
21216-2335
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-3111
  • Fax:
Mailing address:
  • Phone: 410-233-3111
  • Fax: 410-233-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC0488
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: