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General NPI Number Information
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NPI Number | 1609741370
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Entity Type | Individual
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Provider Name | JILLIAN CARROLL
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Gender | Female
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 855 BOWSPRIT RD
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City | CHULA VISTA
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State | CA
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Zip | 91914-4529
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Country | US
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Telephone | 619-549-0329
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Fax |
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Provider Business Mailing Address
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Address Line | 5073 CENTRAL AVE UNIT 74
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City | BONITA
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State | CA
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Zip | 91908-3002
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 142689
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License Number State | CA
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