Provider Demographics
NPI:1225207046
Name:CARROLL, LYNNETTE MICHELLE (MAC,MSW,CCDC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:MICHELLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MAC,MSW,CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DICK ST
Mailing Address - Street 2:B-2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5750
Mailing Address - Country:US
Mailing Address - Phone:910-433-5633
Mailing Address - Fax:910-433-2234
Practice Address - Street 1:214 DICK ST
Practice Address - Street 2:B-2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5750
Practice Address - Country:US
Practice Address - Phone:910-433-5633
Practice Address - Fax:910-433-2234
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF19696101YA0400X
MD4181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)