Provider Demographics
NPI:1821143876
Name:CAROLLO, PAUL JOSEPH (MC,NCC,LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:CAROLLO
Suffix:
Gender:M
Credentials:MC,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 E TUMBLEWEED DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4049
Mailing Address - Country:US
Mailing Address - Phone:480-951-2913
Mailing Address - Fax:480-951-2913
Practice Address - Street 1:4614 E SHEA BLVD
Practice Address - Street 2:SUITE D250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3070
Practice Address - Country:US
Practice Address - Phone:602-953-9070
Practice Address - Fax:602-953-9077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional