Provider Demographics
NPI:1437406832
Name:CARROLL, LINDER (MA, MED, LMHC)
Entity Type:Individual
Prefix:
First Name:LINDER
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 NW DENNIS GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-2980
Mailing Address - Country:US
Mailing Address - Phone:850-933-2447
Mailing Address - Fax:
Practice Address - Street 1:1690 NW DENNIS GREEN RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-2980
Practice Address - Country:US
Practice Address - Phone:850-933-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional