Healthcare Provider Details

I. General information

NPI: 1316009640
Provider Name (Legal Business Name): DAVID CARROLL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

412 E HERMOSA ST
SANTA MARIA CA
93454-3730
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: