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General NPI Number Information
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NPI Number | 1255842001
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Entity Type | Organization
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Legal Business Name | CARTERS COMPREHENSIVE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 2311 PINEFIELD RD
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City | WALDORF
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State | MD
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Zip | 20601-3235
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Country | US
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Telephone | 240-412-7039
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 PINEFIELD RD
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City | WALDORF
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State | MD
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Zip | 20601-3235
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Country | US
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Telephone | 240-412-7039
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Fax |
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Authorized Official
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Title or Position | OWNER/ CEO
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Name | DAWN NICOLE GILLOM-CARTER
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Credential | MHS,MS, HS-BCP
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Telephone | 240-412-7039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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