Provider Demographics
NPI:1659039121
Name:CARROLL MARTIN LCSW - LLC
Entity Type:Organization
Organization Name:CARROLL MARTIN LCSW - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-406-1717
Mailing Address - Street 1:41631 OLIVINE PL
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5682
Mailing Address - Country:US
Mailing Address - Phone:703-775-4102
Mailing Address - Fax:
Practice Address - Street 1:41631 OLIVINE PL
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5682
Practice Address - Country:US
Practice Address - Phone:703-775-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARROLL MARTIN LCSW - LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty