Basic Information
| Provider Information | |||||||||
| NPI: | 1427121177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 AUDUBON DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481036183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346658074 | ||||||||
| FaxNumber: | 7346658079 | ||||||||
| Practice Location | |||||||||
| Address1: | 6223 N CANTON CENTER RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481872696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347371200 | ||||||||
| FaxNumber: | 7347371205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 104100000X | 6801084228 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.