Provider Demographics
NPI:1871567404
Name:CARROLL, DOREEN MARIE (MS LMFT)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VALENCIA DRIVE
Mailing Address - Street 2:STE #161
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-347-9855
Mailing Address - Fax:910-353-4310
Practice Address - Street 1:200 VALENCIA DRIVE
Practice Address - Street 2:STE #161
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-347-9855
Practice Address - Fax:910-353-4310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105050Medicaid