Provider Demographics
NPI:1033264924
Name:CARROLL, JOHN P (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PARSONS RD
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5313
Mailing Address - Country:US
Mailing Address - Phone:207-743-8638
Mailing Address - Fax:
Practice Address - Street 1:336 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6300
Practice Address - Country:US
Practice Address - Phone:207-783-2617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional