Healthcare Provider Details

I. General information

NPI: 1316828130
Provider Name (Legal Business Name): CARTER CAMPBELL TIPTON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 RESEARCH BLVD STE 100
ROCKVILLE MD
20850-6130
US

IV. Provider business mailing address

34 FREEMONT AVE
TAKOMA PARK MD
20912-5730
US

V. Phone/Fax

Practice location:
  • Phone: 240-552-5808
  • Fax:
Mailing address:
  • Phone: 301-219-6398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: