Provider Demographics
NPI:1942494463
Name:GREAVES, CARLISLE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CARLISLE
Middle Name:
Last Name:GREAVES
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 VISTA HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2895
Mailing Address - Country:US
Mailing Address - Phone:240-210-6613
Mailing Address - Fax:
Practice Address - Street 1:10300 VISTA HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2895
Practice Address - Country:US
Practice Address - Phone:240-210-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD941L70Medicare UPIN
MD58956180Medicaid