Provider Demographics
NPI:1043348121
Name:CARROLL, BETSY LANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:LANE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WALDEN CREEK TRACE
Mailing Address - Street 2:STE 162G
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174
Mailing Address - Country:US
Mailing Address - Phone:615-812-6449
Mailing Address - Fax:
Practice Address - Street 1:145 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2411
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:615-781-0688
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000047601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1043348121Medicaid