Healthcare Provider Details

I. General information

NPI: 1396401824
Provider Name (Legal Business Name): JAMES CARROLL LMHC-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 ROUTE 9 STE 101
HALFMOON NY
12065-2467
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-1091
  • Fax: 518-881-0796
Mailing address:
  • Phone: 518-782-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP114570
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: