Basic Information
| Provider Information | |||||||||
| NPI: | 1316396260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.A., LPC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LAIL | ||||||||
| OtherFirstName: | JAN | ||||||||
| OtherMiddleName: | ELAINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 327 1ST AVE NW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286016122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286955900 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 RODORET ST N | ||||||||
| Address2: | |||||||||
| City: | VALDESE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286902335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283689273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2016 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A12039 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.