Provider Demographics
NPI:1225428139
Name:CARTER, KEVIN MARK (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MARK
Last Name:CARTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CRAIN HWY STE 304
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4843
Mailing Address - Country:US
Mailing Address - Phone:240-419-3803
Mailing Address - Fax:240-419-2931
Practice Address - Street 1:2311 PINEFIELD RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3235
Practice Address - Country:US
Practice Address - Phone:240-346-5541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional