Provider Demographics
NPI:1154196277
Name:CARNATION AND ARROW THERAPEUTIC SERVICES, LC
Entity type:Organization
Organization Name:CARNATION AND ARROW THERAPEUTIC SERVICES, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLEY
Authorized Official - Middle Name:KELCEE
Authorized Official - Last Name:AGUEDA-DIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-540-8280
Mailing Address - Street 1:800 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2537
Mailing Address - Country:US
Mailing Address - Phone:443-540-8280
Mailing Address - Fax:
Practice Address - Street 1:800 W 36TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2537
Practice Address - Country:US
Practice Address - Phone:240-593-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty