Provider Demographics
NPI:1851976401
Name:CARROLL, TASHA (CMHT)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 CARROLL DR
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2036
Mailing Address - Country:US
Mailing Address - Phone:601-894-2018
Mailing Address - Fax:601-894-1748
Practice Address - Street 1:1019 CARROLL DR
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2036
Practice Address - Country:US
Practice Address - Phone:601-894-2018
Practice Address - Fax:601-894-1748
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health