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General NPI Number Information
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NPI Number | 1568258697
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Entity Type | Individual
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Provider Name | CONLEY MAURICE CARTER JR.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1930 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-7006
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Country | US
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Telephone | 202-450-5822
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 OLD BRIDGE RD STE 210
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City | WOODBRIDGE
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State | VA
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Zip | 22192-8006
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Country | US
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Telephone | 202-967-7262
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00859400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGPC200001923
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License Number State | DC
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