Provider Demographics
NPI:1114794104
Name:CARROLL, PORTIA (TLMFT)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:PORTIA
Other - Middle Name:
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 UPTOWN SQ
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0573
Mailing Address - Country:US
Mailing Address - Phone:931-486-8670
Mailing Address - Fax:615-796-6911
Practice Address - Street 1:201 UPTOWN SQ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0573
Practice Address - Country:US
Practice Address - Phone:931-486-8670
Practice Address - Fax:615-796-6911
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist