Provider Demographics
NPI:1467663849
Name:HERDER, CAROL (LGPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HERDER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10123 SENATE DR
Mailing Address - Street 2:1ST FL.
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4367
Mailing Address - Country:US
Mailing Address - Phone:301-459-9840
Mailing Address - Fax:
Practice Address - Street 1:10123 SENATE DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4367
Practice Address - Country:US
Practice Address - Phone:301-459-9840
Practice Address - Fax:301-459-4856
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP154Medicaid