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NPI Code Detail

MEDICARE: DYRELL CARR

MEDICARE: DYRELL CARR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health CounselorAPC007369GA

General Provider Information

NPI Number : 1700332228
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYRELL CARR
Provider Business Mailing Address
First Line : 2247 HUMMINGBIRD LN
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22911-8304
Country : US
Telephone Number : 434-906-7702
Fax Number :
Provider Business Practice Location Address
First Line : 1030 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2921
Country : US
Telephone Number : 404-486-9034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2016
Last Update Date : 11/19/2020

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Directions to “ DYRELL CARR ” Practice Location

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