Provider Demographics
NPI:1770570574
Name:NELSON, CAROLYN LANTZY (LCSW-C, CAC-AD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LANTZY
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW-C, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 TIMBER TRL APT D
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3147
Mailing Address - Country:US
Mailing Address - Phone:410-610-7469
Mailing Address - Fax:
Practice Address - Street 1:222 TIMBER TRL APT D
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3147
Practice Address - Country:US
Practice Address - Phone:410-610-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1178101YA0400X
MD125841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)