Provider Demographics
NPI:1235482761
Name:ALLEY, CARROLL L (CAC III)
Entity Type:Individual
Prefix:MRS
First Name:CARROLL
Middle Name:L
Last Name:ALLEY
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:MISS
Other - First Name:CARROLL
Other - Middle Name:L
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAC III
Mailing Address - Street 1:7373 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-1446
Mailing Address - Country:US
Mailing Address - Phone:303-412-3965
Mailing Address - Fax:303-412-3342
Practice Address - Street 1:7373 BIRCH ST
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-1446
Practice Address - Country:US
Practice Address - Phone:303-412-3965
Practice Address - Fax:303-412-3342
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6990101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)