Provider Demographics
NPI:1801286950
Name:FLETCHER, CARNECIA MONIQUE (LCSW-C)
Entity type:Individual
Prefix:
First Name:CARNECIA
Middle Name:MONIQUE
Last Name:FLETCHER
Suffix:
Gender:
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 HOMEWOOD AVE # 21218
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6148
Mailing Address - Country:US
Mailing Address - Phone:843-697-7016
Mailing Address - Fax:
Practice Address - Street 1:2101 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5981
Practice Address - Country:US
Practice Address - Phone:646-961-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC164351041C0700X
MD306571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD224317200Medicaid
SC435201Medicaid