Provider Demographics
NPI:1568669737
Name:CARROLL, VICKI LYNN
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-8922
Mailing Address - Country:US
Mailing Address - Phone:541-673-5324
Mailing Address - Fax:
Practice Address - Street 1:612 SE JACKSON ST STE 11
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4956
Practice Address - Country:US
Practice Address - Phone:541-464-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor