Provider Demographics
NPI:1972656999
Name:CARROLL, ELEANOR (PHD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 FOXBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5765
Mailing Address - Country:US
Mailing Address - Phone:980-253-6150
Mailing Address - Fax:
Practice Address - Street 1:941 FOXBOROUGH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5765
Practice Address - Country:US
Practice Address - Phone:980-253-6150
Practice Address - Fax:704-598-2490
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2774103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000279Medicaid