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General NPI Number Information
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NPI Number | 1710706676
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Entity Type | Individual
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Provider Name | MS. JANAE ALEXIS CARROLL
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Gender | Female
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 10150 MALLARD CREEK RD STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4567
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Country | US
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Telephone | 980-242-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 6049 PINETOWN RD
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City | OXFORD
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State | NC
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Zip | 27565-7956
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A20641
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A20641
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License Number State | NC
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