Provider Demographics
NPI:1730863622
Name:MICHAEL CARDACI, LCPC, LLC
Entity type:Organization
Organization Name:MICHAEL CARDACI, LCPC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARDACI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-714-1720
Mailing Address - Street 1:242 NATHAN WAY
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1033
Mailing Address - Country:US
Mailing Address - Phone:410-714-1720
Mailing Address - Fax:
Practice Address - Street 1:2616 CHAPEL LAKE DR STE B
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1637
Practice Address - Country:US
Practice Address - Phone:410-714-1720
Practice Address - Fax:410-775-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty