Provider Demographics
NPI:1255903340
Name:GADSDEN, CARRIE MELISSA (EDS)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:MELISSA
Last Name:GADSDEN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7724 ALASTOR CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-8167
Mailing Address - Country:US
Mailing Address - Phone:951-283-2853
Mailing Address - Fax:
Practice Address - Street 1:7724 ALASTOR CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-8167
Practice Address - Country:US
Practice Address - Phone:951-283-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180099252103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool