Healthcare Provider Details

I. General information

NPI: 1760684674
Provider Name (Legal Business Name): JAMES B. CARROLL LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LINCOLN PLACE CT STE 406
BELLEVILLE IL
62221-5825
US

IV. Provider business mailing address

131 LINCOLN PLACE CT STE 406
BELLEVILLE IL
62221-5825
US

V. Phone/Fax

Practice location:
  • Phone: 618-631-2683
  • Fax:
Mailing address:
  • Phone: 618-631-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number18004287
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180004287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: