Doctor Name: | CHERI CARROLL |
NPI Number: | 1083747356 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 149008961 |
Business Practice Address: | 405 Kays Dr Ste C Normal, IL - 617611979 |
Business Phone Number: | 3096643130 |
Business Fax Number: | 3096643528 |
Mailing Address: | 405 Kays Dr Ste C, NORMAL |
State: | IL |
Postal Code: | 617611979 |
Phone Number: | 3096643130 |
Fax Number: | 3096643528 |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 05/09/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149008961 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |