Provider Demographics
NPI:1790247203
Name:VEIZAGA-UDAETA, CARLA EDITH (MA, LGPC)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:EDITH
Last Name:VEIZAGA-UDAETA
Suffix:
Gender:F
Credentials:MA, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18904 MILLS CHOICE RD APT 6
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3850
Mailing Address - Country:US
Mailing Address - Phone:301-525-1102
Mailing Address - Fax:
Practice Address - Street 1:620 E DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5320
Practice Address - Country:US
Practice Address - Phone:240-683-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional