Healthcare Provider Details

I. General information

NPI: 1043125339
Provider Name (Legal Business Name): ANGELIA JOY CARSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STAFFORD RD
PRINCE FREDERICK MD MD
20678
US

IV. Provider business mailing address

280 STAFFORD RD
PRINCE FREDERICK MD
20678-3582
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-3079
  • Fax:
Mailing address:
  • Phone: 410-535-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMD-10272845942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: