Provider Demographics
NPI:1851857429
Name:MCKISSICK, CAROL ANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MCKISSICK
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 1:3300 BOUNTIFUL DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7530
Mailing Address - Country:US
Mailing Address - Phone:443-520-4374
Mailing Address - Fax:
Practice Address - Street 1:2850 N. RIDGE RD. SUITE 208A
Practice Address - Street 2:SANTORO PSYCHOLOGICAL SERVICES
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-988-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8698101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional