Provider Demographics
NPI:1659315141
Name:CARROLL, IRENE G (LPC)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:G
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5922
Mailing Address - Country:US
Mailing Address - Phone:704-779-0372
Mailing Address - Fax:704-358-0876
Practice Address - Street 1:2237 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5922
Practice Address - Country:US
Practice Address - Phone:704-779-0372
Practice Address - Fax:704-358-0876
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional