Provider Demographics
NPI:1881205490
Name:CARROLL, CHARITY JO (BS)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:JO
Last Name:CARROLL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3383 MIDDLE GRAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-3367
Mailing Address - Country:US
Mailing Address - Phone:304-559-6045
Mailing Address - Fax:304-845-9977
Practice Address - Street 1:3383 MIDDLE GRAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-3367
Practice Address - Country:US
Practice Address - Phone:304-559-6045
Practice Address - Fax:304-845-9977
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator