Healthcare Provider Details

I. General information

NPI: 1194097865
Provider Name (Legal Business Name): PAUL CARROLA M.A., LPC-S, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 GRISSOM RD STE 128
SAN ANTONIO TX
78238-3038
US

IV. Provider business mailing address

500 N SANTA ROSA ST APT 722
SAN ANTONIO TX
78207-3134
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-4747
  • Fax:
Mailing address:
  • Phone: 210-287-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number60660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: