Provider Demographics
NPI:1851330344
Name:CARROLL, JANE JUDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:JUDY
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:211 SUNSET DR.
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-1208
Mailing Address - Country:US
Mailing Address - Phone:828-664-1695
Mailing Address - Fax:
Practice Address - Street 1:211 SUNSET DR
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3809
Practice Address - Country:US
Practice Address - Phone:828-664-1695
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21201OtherBLUECROSS BLUESHIELD NC
NC6103078Medicaid