Provider Demographics
NPI:1093186462
Name:CARROWAY, JOSIE
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:CARROWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2551A KENNEDY
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-3125
Mailing Address - Country:US
Mailing Address - Phone:850-776-5060
Mailing Address - Fax:
Practice Address - Street 1:2551 A KENNEDY
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93254
Practice Address - Country:US
Practice Address - Phone:850-776-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36872286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)