Provider Demographics
NPI:1649308206
Name:CARROLL-JAMES, NANNETTE CHARLOTTE (CSCAD)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:CHARLOTTE
Last Name:CARROLL-JAMES
Suffix:
Gender:F
Credentials:CSCAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6363
Mailing Address - Country:US
Mailing Address - Phone:410-609-4748
Mailing Address - Fax:
Practice Address - Street 1:910 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4516
Practice Address - Country:US
Practice Address - Phone:410-853-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)