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NPI Code Detail

MEDICARE: MRS. TARA COLLEEN CARLETON LCPC, NCC

MEDICARE: MRS. TARA COLLEEN CARLETON LCPC, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLC10292MD

General Provider Information

NPI Number : 1245648864
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA COLLEEN CARLETON LCPC, NCC
Provider Business Mailing Address
First Line : 400 MADISON DR
Second Line :
City : SHREWSBURY
State : PA
Zip : 17361-1629
Country : US
Telephone Number : 215-534-2095
Fax Number :
Provider Business Practice Location Address
First Line : 1208 E CHURCHVILLE RD STE 300
Second Line :
City : BEL AIR
State : MD
Zip : 21014-3485
Country : US
Telephone Number : 410-893-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2014
Last Update Date : 02/21/2020

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