Provider Demographics
NPI:1912223884
Name:CAROLLA, JAMES (MA, MFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CAROLLA
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3506
Mailing Address - Country:US
Mailing Address - Phone:818-618-6074
Mailing Address - Fax:
Practice Address - Street 1:1921 HARDING AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3506
Practice Address - Country:US
Practice Address - Phone:818-618-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist