Provider Demographics
NPI:1851674782
Name:MCCARRICK, CAROL J
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:MCCARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-6624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 W HONDO AVE BLDG 100
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-1921
Practice Address - Country:US
Practice Address - Phone:830-663-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)