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General NPI Number Information
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NPI Number | 1811863236
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Entity Type | Individual
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Provider Name | CARLY CANNAVINA LGPC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 6110 EXECUTIVE BLVD STE 540
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City | NORTH BETHESDA
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State | MD
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Zip | 20852-3948
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Country | US
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Telephone | 202-750-1028
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Fax |
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Provider Business Mailing Address
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Address Line | 148 SUN VALLEY WAY
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City | MORRIS PLAINS
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State | NJ
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Zip | 07950-2042
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Country | US
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Telephone | 973-452-7300
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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 | LGPC200002983
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License Number State | DC
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