Provider Demographics
NPI:1891933594
Name:CARROLL, ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 TEMPERANCE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-7294
Mailing Address - Country:US
Mailing Address - Phone:270-792-1563
Mailing Address - Fax:
Practice Address - Street 1:1143 FAIRWAY ST STE 3
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2452
Practice Address - Country:US
Practice Address - Phone:270-904-6307
Practice Address - Fax:270-904-6314
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100365090Medicaid
KY3923OtherLCSW