Provider Demographics
NPI:1346304102
Name:CAROLLA, MIKE THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:THOMAS
Last Name:CAROLLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1127
Mailing Address - Country:US
Mailing Address - Phone:925-932-0150
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY STE 606
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4337
Practice Address - Country:US
Practice Address - Phone:925-932-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT35316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health