Provider Demographics
NPI:1982759684
Name:PRINCE, CAROLYN ELIZABETH (LCSW-C, LCADC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LCSW-C, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W. PENNSYLVANIA AVE.
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-494-0044
Mailing Address - Fax:
Practice Address - Street 1:402 W. PENNSYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-494-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA017101YA0400X
MD038761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical