Provider Demographics
NPI:1528030723
Name:CARROLL, WILLIAM MARTIEN (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARTIEN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MARTIEN
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 20705
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-0705
Mailing Address - Country:US
Mailing Address - Phone:501-623-7392
Mailing Address - Fax:501-623-7392
Practice Address - Street 1:109 TALISMAN
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7454
Practice Address - Country:US
Practice Address - Phone:501-623-7392
Practice Address - Fax:501-623-7392
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR737P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56151OtherBLUE CROSS/ BLUE SHIELD
AR56151Medicare PIN