Provider Demographics
NPI:1609188549
Name:CARROLL, DORIS ANN (LMHC, MCAP)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 626
Mailing Address - Street 2:
Mailing Address - City:POMONA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32181
Mailing Address - Country:US
Mailing Address - Phone:561-632-5663
Mailing Address - Fax:
Practice Address - Street 1:1125 N. SUMMIT ST.
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112
Practice Address - Country:US
Practice Address - Phone:561-632-5663
Practice Address - Fax:561-615-0045
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12013101YM0800X, 101YA0400X
101YM0800X
FL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH12013OtherDEPARTMENT OF HEALTH