Provider Demographics
NPI:1023623568
Name:CARLYLE, CARITA (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:CARITA
Middle Name:
Last Name:CARLYLE
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:MRS
Other - First Name:CARITA
Other - Middle Name:
Other - Last Name:CARLYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCMH
Mailing Address - Street 1:138 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BETHANY
Mailing Address - State:DE
Mailing Address - Zip Code:19930-9748
Mailing Address - Country:US
Mailing Address - Phone:443-253-0328
Mailing Address - Fax:
Practice Address - Street 1:138 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BETHANY
Practice Address - State:DE
Practice Address - Zip Code:19930-9748
Practice Address - Country:US
Practice Address - Phone:443-253-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health