Doctor Name: | NATHANIEL EUGENE CARLISLE |
NPI Number: | 1235399320 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | LC1978 |
Business Practice Address: | 8109 Harford Rd Parkville, MD - 212349205 |
Business Phone Number: | 4106652900 |
Business Fax Number: | |
Mailing Address: | 5345 Glen Arm Rd, GLEN ARM |
State: | MD |
Postal Code: | 210579302 |
Phone Number: | 4106880157 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2008 |
NPI Last Update Date: | 06/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LC1978 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |