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General NPI Number Information
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NPI Number | 1225622103
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Entity Type | Individual
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Provider Name | CAROLYN HARRISON LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 134 MAIN ST STE 103
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-6150
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Country | US
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Telephone | 301-690-8404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2514
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City | LEONARDTOWN
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State | MD
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Zip | 20650-8514
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Country | US
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Telephone | 301-690-8404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11023
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License Number State | MD
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