Provider Demographics
NPI:1447597158
Name:METTUS, CAROL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:METTUS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 GROVE RD
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5155
Mailing Address - Country:US
Mailing Address - Phone:202-360-1630
Mailing Address - Fax:
Practice Address - Street 1:7310 GROVE RD
Practice Address - Street 2:SUITE # 207
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5155
Practice Address - Country:US
Practice Address - Phone:202-360-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical