Provider Demographics
NPI:1205221421
Name:CARRINGTON, MICHELLE (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CARRINGTON
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 BROOKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6662
Mailing Address - Country:US
Mailing Address - Phone:240-393-1943
Mailing Address - Fax:
Practice Address - Street 1:10301 BROOKHAVEN LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6662
Practice Address - Country:US
Practice Address - Phone:240-393-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3756133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8740143Medicaid
MD8740143Medicaid