Provider Demographics
NPI:1700903614
Name:CARROLL, DARCY
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:CARROLL
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 1:101 N LA BREA AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1769
Mailing Address - Country:US
Mailing Address - Phone:310-412-0202
Mailing Address - Fax:310-412-9580
Practice Address - Street 1:101 N LA BREA AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1769
Practice Address - Country:US
Practice Address - Phone:310-412-0202
Practice Address - Fax:310-412-9580
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist