Provider Demographics
NPI:1023246196
Name:MCDONALD, CARRIE B (LCSW-C)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:MCDONALD
Suffix:
Gender:F
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 1:922 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7325
Mailing Address - Country:US
Mailing Address - Phone:240-362-7294
Mailing Address - Fax:240-362-7366
Practice Address - Street 1:922 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7325
Practice Address - Country:US
Practice Address - Phone:240-362-7294
Practice Address - Fax:240-362-7366
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD91337500Medicaid
MD411401YL4GMedicare PIN