Doctor Name: | JAMES B. CARROLL |
NPI Number: | 1760684674 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 114 Sherman St Nokomis, IL - 620751148 |
Business Phone Number: | 2175632416 |
Business Fax Number: | |
Mailing Address: | 8250 Frost Ave, SAINT LOUIS |
State: | MO |
Postal Code: | 631341205 |
Phone Number: | 3145214676 |
Fax Number: | |
NPI Enumeration Date: | 06/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |