Basic Information
| Provider Information | |||||||||
| NPI: | 1699010405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARROLL CARE MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 AUDUBON DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481036183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346493065 | ||||||||
| FaxNumber: | 7346658079 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 AUDUBON DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481036183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346493065 | ||||||||
| FaxNumber: | 7346658079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2012 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | CARROLL | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7346493065 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW, ACSW, C-ASWCM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6801084228 | MI | Y | Agencies | Community/Behavioral Health |
No ID Information.