Provider Demographics
NPI:1164800512
Name:DOLL, CAROL J (CATC-IV)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:DOLL
Suffix:
Gender:F
Credentials:CATC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W SPRING ST
Mailing Address - Street 2:UNIT E
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1473
Mailing Address - Country:US
Mailing Address - Phone:562-234-9351
Mailing Address - Fax:
Practice Address - Street 1:2101 E FIRST STREET
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-542-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134100-IV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)