Healthcare Provider Details

I. General information

NPI: 1558275305
Provider Name (Legal Business Name): CARROLL COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 12TH AVE
NAPERVILLE IL
60563-2617
US

IV. Provider business mailing address

1552 S ROUTE 59 # 1043
NAPERVILLE IL
60564-5941
US

V. Phone/Fax

Practice location:
  • Phone: 847-909-1504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE CARROLL
Title or Position: OWNER
Credential: LMFT
Phone: 847-909-1504