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NPI Code Detail

MEDICARE: BROCK CARDER LGPC

MEDICARE: BROCK CARDER LGPC
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
1101YM0800XMental Health Counselor15763MD

General Provider Information

NPI Number : 1821455973
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROCK CARDER LGPC
Provider Business Mailing Address
First Line : 9627 PHILADELPHIA RD STE 160
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4157
Country : US
Telephone Number : 410-780-5203
Fax Number : 410-780-5205
Provider Business Practice Location Address
First Line : 9627 PHILADELPHIA RD STE 160
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4157
Country : US
Telephone Number : 410-780-5203
Fax Number : 410-780-5205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2016
Last Update Date : 08/19/2025

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Directions to “ BROCK CARDER LGPC” Practice Location

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