Provider Demographics
NPI:1851771463
Name:CARTER, TYLYNN
Entity Type:Individual
Prefix:
First Name:TYLYNN
Middle Name:
Last Name:CARTER
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 1:10157 PLACID LAKE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2569
Mailing Address - Country:US
Mailing Address - Phone:717-592-9211
Mailing Address - Fax:
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-337-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30436426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health