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NPI Code Detail

MEDICARE: MRS. JESSICA RAE CARROLL LCPC

MEDICARE:  MRS. JESSICA RAE CARROLL  LCPC
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 CounselorLGP10314MD

General Provider Information

NPI Number : 1689201790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA RAE CARROLL LCPC
Provider Business Mailing Address
First Line : 906 WHITE WAY
Second Line :
City : LAUREL
State : MD
Zip : 20707-3844
Country : US
Telephone Number : 301-237-6234
Fax Number :
Provider Business Practice Location Address
First Line : 8118 GOOD LUCK RD
Second Line :
City : LANHAM
State : MD
Zip : 20706-3574
Country : US
Telephone Number : 301-552-5187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2020
Last Update Date : 07/30/2022

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Directions to “ MRS. JESSICA RAE CARROLL LCPC” Practice Location

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