Provider Demographics
NPI:1538667175
Name:CARROLL, ANNEMARIE (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:ANNEMARIE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 OAK CREST AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-4609
Mailing Address - Country:US
Mailing Address - Phone:540-798-8478
Mailing Address - Fax:
Practice Address - Street 1:1420 3RD ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5205
Practice Address - Country:US
Practice Address - Phone:540-798-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical