Provider Demographics
NPI:1760684674
Name:CARROLL, JAMES B (LCPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:CARROLL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FOUR SEASONS SHOPPING CTR
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3173
Mailing Address - Country:US
Mailing Address - Phone:314-651-6679
Mailing Address - Fax:
Practice Address - Street 1:106 FOUR SEASONS SHOPPING CTR
Practice Address - Street 2:SUITE 103B
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3173
Practice Address - Country:US
Practice Address - Phone:314-651-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional