Provider Demographics
NPI:1316396260
Name:CARROLL, JAN LAIL (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:LAIL
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:ELAINE
Other - Last Name:LAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 WILKESBORO BLVD NE STE 1A
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4498
Mailing Address - Country:US
Mailing Address - Phone:828-754-6087
Mailing Address - Fax:828-754-1344
Practice Address - Street 1:315 WILKESBORO BLVD NE STE 1A
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4498
Practice Address - Country:US
Practice Address - Phone:828-754-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12039101YM0800X
NCA12039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional