Healthcare Provider Details

I. General information

NPI: 1104577618
Provider Name (Legal Business Name): MARGARET CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

IV. Provider business mailing address

PO BOX 318
YORKLYN DE
19736-0318
US

V. Phone/Fax

Practice location:
  • Phone: 484-440-9416
  • Fax:
Mailing address:
  • Phone: 302-753-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC018420
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: