Provider Demographics
NPI:1023409232
Name:SMITH, CARLA P (PHD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:P
Other - Last Name:NANCOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6340 SECURITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5284
Mailing Address - Country:US
Mailing Address - Phone:404-482-3161
Mailing Address - Fax:
Practice Address - Street 1:5002 JUDICIAL WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-4807
Practice Address - Country:US
Practice Address - Phone:404-482-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001383106H00000X
GACSW0053811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist