Provider Demographics
NPI:1396401824
Name:CARROLL, JAMES (MHC(P))
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MHC(P)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GRACE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1139
Mailing Address - Country:US
Mailing Address - Phone:518-423-5179
Mailing Address - Fax:
Practice Address - Street 1:1641 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1539
Practice Address - Country:US
Practice Address - Phone:518-463-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NYP114570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program