Provider Demographics
NPI:1134585631
Name:CARROLL, WILLIAM G (MA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BISHOP MILL DR NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8300
Mailing Address - Country:US
Mailing Address - Phone:770-608-7659
Mailing Address - Fax:
Practice Address - Street 1:316 ALEXANDER ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8217
Practice Address - Country:US
Practice Address - Phone:770-608-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003891101YP2500X
GALPC009564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional