Provider Demographics
NPI:1225354590
Name:BOOTH, CARRIE MELISSA (LCPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MELISSA
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 SNUG HILL LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4057
Mailing Address - Country:US
Mailing Address - Phone:301-518-3814
Mailing Address - Fax:
Practice Address - Street 1:8320 SNUG HILL LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4057
Practice Address - Country:US
Practice Address - Phone:301-518-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional