Healthcare Provider Details

I. General information

NPI: 1124804588
Provider Name (Legal Business Name): CHERESE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15480 ANNAPOLIS RD STE 202
BOWIE MD
20715-1803
US

IV. Provider business mailing address

15480 ANNAPOLIS RD STE 202
BOWIE MD
20715-1803
US

V. Phone/Fax

Practice location:
  • Phone: 240-221-1514
  • Fax:
Mailing address:
  • Phone: 240-221-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200012822
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC13947
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015050
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92720
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: