Healthcare Provider Details

I. General information

NPI: 1023409232
Provider Name (Legal Business Name): CARLA P SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA P NANCOO PHD

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 240-200-4519
  • Fax:
Mailing address:
  • Phone: 240-200-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005381
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: