Healthcare Provider Details

I. General information

NPI: 1194170332
Provider Name (Legal Business Name): SHAWN CARROLL LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10865 US HIGHWAY 278 E STE A
HOLLY POND AL
35083-6884
US

IV. Provider business mailing address

PO BOX 143
BAILEYTON AL
35019-0143
US

V. Phone/Fax

Practice location:
  • Phone: 205-446-0294
  • Fax: 888-500-5517
Mailing address:
  • Phone: 205-446-0294
  • Fax: 888-500-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3421
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: