Provider Demographics
NPI:1396590204
Name:BAXTER CARTER, DIANISHA
Entity type:Individual
Prefix:
First Name:DIANISHA
Middle Name:
Last Name:BAXTER CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7893
Mailing Address - Country:US
Mailing Address - Phone:443-315-3350
Mailing Address - Fax:
Practice Address - Street 1:845 QUINCE ORCHARD BLVD STE F
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1676
Practice Address - Country:US
Practice Address - Phone:301-769-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health