Provider Demographics
NPI:1770122145
Name:KENTLANDS PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:KENTLANDS PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:240-252-3349
Mailing Address - Street 1:301 INSPIRATION LN FL 2
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5817
Mailing Address - Country:US
Mailing Address - Phone:240-252-3349
Mailing Address - Fax:240-477-5265
Practice Address - Street 1:301 INSPIRATION LN FL 2
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5817
Practice Address - Country:US
Practice Address - Phone:240-252-3349
Practice Address - Fax:240-477-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty