Provider Demographics
NPI:1790089613
Name:CARROLL, BRIAN CHRISTOPHER (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2731 SUNBERRY LN NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6555
Mailing Address - Country:US
Mailing Address - Phone:704-918-8302
Mailing Address - Fax:704-782-2918
Practice Address - Street 1:2731 SUNBERRY LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6555
Practice Address - Country:US
Practice Address - Phone:704-918-8302
Practice Address - Fax:704-782-2918
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist