Provider Demographics
NPI:1801418173
Name:SLACK, KARA (LCPC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:SLACK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 LONDONTOWN BLVD STE 108D
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6587
Mailing Address - Country:US
Mailing Address - Phone:443-620-3659
Mailing Address - Fax:
Practice Address - Street 1:1332 LONDONTOWN BLVD STE 108D
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6587
Practice Address - Country:US
Practice Address - Phone:443-620-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCP10689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health