Provider Demographics
NPI:1679170880
Name:MULROONEY, CARRINGTON CROFT (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRINGTON
Middle Name:CROFT
Last Name:MULROONEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:CARRINGTON
Other - Last Name:CROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:5004 MONUMENT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3629
Mailing Address - Country:US
Mailing Address - Phone:804-440-1489
Mailing Address - Fax:
Practice Address - Street 1:5004 MONUMENT AVE STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3629
Practice Address - Country:US
Practice Address - Phone:804-440-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22020067661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist