Provider Demographics
NPI:1699010405
Name:CARROLL CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:CARROLL CARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW, C-ASWCM
Authorized Official - Phone:734-649-3065
Mailing Address - Street 1:2005 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6183
Mailing Address - Country:US
Mailing Address - Phone:734-649-3065
Mailing Address - Fax:734-665-8079
Practice Address - Street 1:2005 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6183
Practice Address - Country:US
Practice Address - Phone:734-649-3065
Practice Address - Fax:734-665-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084228251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health