Provider Demographics
NPI:1609387455
Name:CARROLL, ANDREW BRANTLEY (MS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRANTLEY
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 WAGES WAY S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8062
Mailing Address - Country:US
Mailing Address - Phone:904-400-1080
Mailing Address - Fax:
Practice Address - Street 1:435 CLARK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5596
Practice Address - Country:US
Practice Address - Phone:904-765-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health