Provider Demographics
NPI:1508434945
Name:CARROLL, EVETTE N (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:N
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 NEWBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2305
Mailing Address - Country:US
Mailing Address - Phone:313-207-3057
Mailing Address - Fax:
Practice Address - Street 1:5355 NEWBERRY ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2305
Practice Address - Country:US
Practice Address - Phone:313-207-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010824411041C0700X
MI1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool