Provider Demographics
NPI:1871725382
Name:CARROLL, RENAY HORSLEY
Entity type:Individual
Prefix:MRS
First Name:RENAY
Middle Name:HORSLEY
Last Name:CARROLL
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:P.O. BOX 361767, 2681 ROCKY RIDGE LANE
Mailing Address - Street 2:ALABAMA BAPTIST CHILDRENS HOME - FAMILY MINISTERS
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35236-1767
Mailing Address - Country:US
Mailing Address - Phone:205-945-0037
Mailing Address - Fax:205-945-0031
Practice Address - Street 1:898 SPRINGVILLE BLVD
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121
Practice Address - Country:US
Practice Address - Phone:205-274-2879
Practice Address - Fax:205-625-3207
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1322101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor