Provider Demographics
NPI:1497096622
Name:VAN DOORN, CAROL PATTERSON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:PATTERSON
Last Name:VAN DOORN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:VAN DOORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1743 CASTLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-9386
Mailing Address - Country:US
Mailing Address - Phone:301-351-7421
Mailing Address - Fax:
Practice Address - Street 1:209 CENTER ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6309
Practice Address - Country:US
Practice Address - Phone:301-351-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0648124 00Medicaid