Provider Demographics
NPI:1083478499
Name:CARTER, KELLI E (LGPC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:E
Last Name:CARTER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 TOWER OAKS BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4295
Mailing Address - Country:US
Mailing Address - Phone:240-449-4131
Mailing Address - Fax:
Practice Address - Street 1:3202 TOWER OAKS BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4295
Practice Address - Country:US
Practice Address - Phone:240-449-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health