Provider Demographics
NPI:1851431258
Name:CARROLL, JACQUELINE (LMHC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 N COLLEGE AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2734
Mailing Address - Country:US
Mailing Address - Phone:317-789-6108
Mailing Address - Fax:
Practice Address - Street 1:3901 N COLLEGE AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2734
Practice Address - Country:US
Practice Address - Phone:317-931-8018
Practice Address - Fax:317-931-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3900022A101YA0400X
IN39000822A101YP1600X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300022920Medicaid