Provider Demographics
NPI:1952995797
Name:BOONE, CARRIE SHADONNA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:SHADONNA
Last Name:BOONE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:S
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5004 HONEYGO CENTER DR STE 218
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8963
Mailing Address - Country:US
Mailing Address - Phone:410-960-9454
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE 305A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2111
Practice Address - Country:US
Practice Address - Phone:410-498-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD209921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty