Provider Demographics
NPI:1760783187
Name:ROBERSON CARTER, DEETTA M (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:DEETTA
Middle Name:M
Last Name:ROBERSON CARTER
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WARREN ROAD
Mailing Address - Street 2:SUITE 25A
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-701-0770
Mailing Address - Fax:443-279-2916
Practice Address - Street 1:17 WARREN ROAD
Practice Address - Street 2:SUITE 25A
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-701-0770
Practice Address - Fax:443-279-2916
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12345104100000X
MD17501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220218200Medicaid
MDAJ47OtherCAREFIRST BCBS
MD220218200Medicaid