Provider Demographics
NPI:1396426912
Name:CARTER, TANEISHA AUTUMN
Entity type:Individual
Prefix:
First Name:TANEISHA
Middle Name:AUTUMN
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1349
Mailing Address - Country:US
Mailing Address - Phone:443-739-2492
Mailing Address - Fax:
Practice Address - Street 1:10451 MILL RUN CIR STE 725
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5577
Practice Address - Country:US
Practice Address - Phone:443-272-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health