Provider Demographics
NPI:1043846686
Name:CARSON, INDIA NYRIE
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:NYRIE
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CARAWAY RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5317
Mailing Address - Country:US
Mailing Address - Phone:443-381-8521
Mailing Address - Fax:
Practice Address - Street 1:202 CARAWAY RD APT 2C
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-5317
Practice Address - Country:US
Practice Address - Phone:443-381-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician