Provider Demographics
NPI:1932317104
Name:KILLORAN, CAROL ANN (DMIN)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:KILLORAN
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 SUTTON LN APT D
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3211
Mailing Address - Country:US
Mailing Address - Phone:440-946-2384
Mailing Address - Fax:
Practice Address - Street 1:35040 CHARDON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9006
Practice Address - Country:US
Practice Address - Phone:440-946-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1816101YM0800X
OHE 1816101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral