Provider Demographics
NPI:1770206203
Name:CARROLL, ANNE M (LMFT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:11925 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3911
Mailing Address - Country:US
Mailing Address - Phone:763-746-0842
Mailing Address - Fax:
Practice Address - Street 1:11188 ZEALAND AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3594
Practice Address - Country:US
Practice Address - Phone:612-991-8949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist