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General NPI Number Information
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NPI Number | 1700966637
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Entity Type | Individual
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Provider Name | CARROLL WILLIS MCINROE LICSW
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4815 N ASSEMBLY ST
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City | SPOKANE
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State | WA
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Zip | 99205-6185
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Country | US
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Telephone | 509-434-7779
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Fax |
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Provider Business Mailing Address
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Address Line | 12112 E BURNETT RD
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City | MEAD
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State | WA
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Zip | 99021-9735
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Country | US
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Telephone | 509-893-2777
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00005901
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License Number State | WA
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