Provider Demographics
NPI:1669097515
Name:CARROLA, GINA F
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:F
Last Name:CARROLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 ARTHUR DR APT 7
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-3731
Mailing Address - Country:US
Mailing Address - Phone:608-957-3798
Mailing Address - Fax:
Practice Address - Street 1:881 ARTHUR DR APT 7
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-3731
Practice Address - Country:US
Practice Address - Phone:608-957-3798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health