Basic Information
| Provider Information | |||||||||
| NPI: | 1164800512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOLL | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CATC-IV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 W SPRING ST | ||||||||
| Address2: | UNIT E | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622349351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 E FIRST STREET | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145423581 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 134100-IV | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.