Provider Demographics
NPI:1811498330
Name:CARROLL, MEGHAN
Entity type:Individual
Prefix:
First Name:MEGHAN
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 1:117 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:AL
Mailing Address - Zip Code:35761-9435
Mailing Address - Country:US
Mailing Address - Phone:919-219-9564
Mailing Address - Fax:
Practice Address - Street 1:101 LOWE AVE SE STE 2A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4237
Practice Address - Country:US
Practice Address - Phone:256-822-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980261041C0700X
AL5061C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL