Provider Demographics
NPI:1699217646
Name:O'CONNOR, CARRIE LEE (LGSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 LITTLE KIDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-1215
Mailing Address - Country:US
Mailing Address - Phone:443-350-3743
Mailing Address - Fax:
Practice Address - Street 1:602 LITTLE KIDWELL AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1215
Practice Address - Country:US
Practice Address - Phone:443-350-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker