Provider Demographics
NPI:1356890941
Name:CARROLL, JULIA L (MED, LCPC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23429 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2732
Mailing Address - Country:US
Mailing Address - Phone:618-363-5411
Mailing Address - Fax:
Practice Address - Street 1:23429 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2732
Practice Address - Country:US
Practice Address - Phone:618-363-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional