Provider Demographics
NPI:1194374835
Name:PENDLETON, CARMEN (LGPC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:PENDLETON
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 1:292 BLOOMSBURY AVE APT B12
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5255
Mailing Address - Country:US
Mailing Address - Phone:484-744-0274
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSROADS DR STE 105
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5480
Practice Address - Country:US
Practice Address - Phone:410-356-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9852101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty