Provider Demographics
NPI:1326105263
Name:THERAPEUTIC SERVICES OF TRACY CARTER, M.S., L.C.P.C., L.L.C.
Entity Type:Organization
Organization Name:THERAPEUTIC SERVICES OF TRACY CARTER, M.S., L.C.P.C., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-598-3186
Mailing Address - Street 1:58 GIRTH LN
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4032
Mailing Address - Country:US
Mailing Address - Phone:410-598-3186
Mailing Address - Fax:
Practice Address - Street 1:507 WEST DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2623
Practice Address - Country:US
Practice Address - Phone:410-598-3186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD274772OtherCOMPSYCH
MD409607000Medicaid
MD4969-0001OtherBCBS FEDERAL
MD100094884OtherAMERICAN PSYCH SYSTEMS
MD17PKTHOtherBCBS LOCAL
MD4969-0001OtherBCBS BLUECHOICE
MD7607810OtherAETNA
MD391360OtherMHN