Healthcare Provider Details

I. General information

NPI: 1871725382
Provider Name (Legal Business Name): MRS. RENAY HORSLEY CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 SPRINGVILLE BLVD
ONEONTA AL
35121
US

IV. Provider business mailing address

P.O. BOX 361767, 2681 ROCKY RIDGE LANE ALABAMA BAPTIST CHILDRENS HOME - FAMILY MINISTERS
BIRMINGHAM AL
35236-1767
US

V. Phone/Fax

Practice location:
  • Phone: 205-274-2879
  • Fax: 205-625-3207
Mailing address:
  • Phone: 205-945-0037
  • Fax: 205-945-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1322
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: