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General NPI Number Information
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NPI Number | 1497381610
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Entity Type | Individual
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Provider Name | ELIZABETH CARROLL
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Gender | Female
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 630 S 36TH AVE
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City | WAUSAU
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State | WI
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Zip | 54401-3930
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Country | US
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Telephone | 855-607-8242
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Fax | 715-848-0425
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Provider Business Mailing Address
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Address Line | 630 S 36TH AVE
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City | WAUSAU
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State | WI
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Zip | 54401-3930
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Country | US
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Telephone | 855-607-8242
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Fax | 715-848-0425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.2103101
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.2002348-TRNE
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C.2002348-TRNE
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License Number State |
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