Provider Demographics
NPI:1710239389
Name:CARROLL, STEPHEN THOMAS (PHD LCPC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:THOMAS
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 NEW HAMPSHIRE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3611
Mailing Address - Country:US
Mailing Address - Phone:301-431-6865
Mailing Address - Fax:
Practice Address - Street 1:8901 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3611
Practice Address - Country:US
Practice Address - Phone:301-431-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional