Healthcare Provider Details

I. General information

NPI: 1255842001
Provider Name (Legal Business Name): CARTERS COMPREHENSIVE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 PINEFIELD RD
WALDORF MD
20601-3235
US

IV. Provider business mailing address

2311 PINEFIELD RD
WALDORF MD
20601-3235
US

V. Phone/Fax

Practice location:
  • Phone: 240-412-7039
  • Fax:
Mailing address:
  • Phone: 240-412-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAWN NICOLE GILLOM-CARTER
Title or Position: OWNER/ CEO
Credential: MHS,MS, HS-BCP
Phone: 240-412-7039