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General NPI Number Information
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NPI Number | 1538667175
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Entity Type | Individual
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Provider Name | ANNEMARIE CARROLL PH.D., LCP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 1420 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-5205
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Country | US
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Telephone | 540-798-8478
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Fax |
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Provider Business Mailing Address
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Address Line | 2921 OAK CREST AVE SW
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City | ROANOKE
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State | VA
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Zip | 24015-4609
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Country | US
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Telephone | 540-798-8478
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003395
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License Number State | VA
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