Provider Demographics
NPI:1841759180
Name:KNEBEL, CARRIE ANNE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANNE
Last Name:KNEBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LABURNUM ST
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2523
Mailing Address - Country:US
Mailing Address - Phone:703-209-8522
Mailing Address - Fax:
Practice Address - Street 1:7520 STANDISH PL STE 190
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2847
Practice Address - Country:US
Practice Address - Phone:703-209-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD076871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical