Provider Demographics
NPI:1225603517
Name:CARROLL, LISA CATHERINE (MBA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CATHERINE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MBA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17028 AIKEN LN
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6349
Mailing Address - Country:US
Mailing Address - Phone:318-237-4748
Mailing Address - Fax:
Practice Address - Street 1:6685 SULLIVAN RD STE B
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3112
Practice Address - Country:US
Practice Address - Phone:225-261-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator