Healthcare Provider Details

I. General information

NPI: 1578282414
Provider Name (Legal Business Name): CAROLYN ANN MORRIS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LIBERTY LN
WEST CARROLLTON OH
45449-2135
US

IV. Provider business mailing address

1169 RIPPLECREEK CT
WASHINGTON TOWNSHIP OH
45458-3229
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-2400
  • Fax: 937-247-2424
Mailing address:
  • Phone: 937-469-5740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0015884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: