Individual
CARRIE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 BENFIELD BLVD, MILLERSVILLE, MD 21108-2568
(410) 780-5203
(410) 780-5205
Mailing address
8967 YELLOW BRICK RD, ROSEDALE, MD 21237-2303
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14799
MD
1041C0700X
Clinical Social Worker
LIC50079475
DC
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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