Provider Demographics
NPI:1821390303
Name:CARROLL, ANNIE LARAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:LARAE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:LARAE
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MSW
Mailing Address - Street 1:57950 LEAVEWORTH ST
Mailing Address - Street 2:
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3900
Mailing Address - Country:US
Mailing Address - Phone:316-759-6100
Mailing Address - Fax:
Practice Address - Street 1:57950 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3505
Practice Address - Country:US
Practice Address - Phone:316-759-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5968-S1041C0700X
NV7357-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical