Provider Demographics
NPI:1619938107
Name:CARDACI, MICHAEL D (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:CARDACI
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 NATHAN WAY
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-6831
Mailing Address - Country:US
Mailing Address - Phone:410-714-1720
Mailing Address - Fax:410-741-3343
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-714-1720
Practice Address - Fax:410-741-3343
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2621101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774800100Medicaid