Provider Demographics
NPI:1114184140
Name:MCCARROLL, DELORES
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:
Last Name:MCCARROLL
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 1:4062 S MUIRFIELD RD
Mailing Address - Street 2:APT D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3010
Mailing Address - Country:US
Mailing Address - Phone:323-299-0782
Mailing Address - Fax:
Practice Address - Street 1:4062 S MUIRFIELD RD
Practice Address - Street 2:APT D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3010
Practice Address - Country:US
Practice Address - Phone:323-299-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health