Provider Demographics
NPI:1811008667
Name:BURESH, CAROLYN MARIE (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:BURESH
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:FORDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0339
Mailing Address - Country:US
Mailing Address - Phone:800-491-5369
Mailing Address - Fax:301-774-3678
Practice Address - Street 1:4550 CENTENNIAL LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6274
Practice Address - Country:US
Practice Address - Phone:800-491-5369
Practice Address - Fax:301-774-3678
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4954101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC4954OtherLCPC
269185OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS