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General NPI Number Information
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NPI Number | 1720343825
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Entity Type | Individual
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Provider Name | CARROLL ANNETTE BEVERLY CADC-M
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Gender | Female
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 3190 HALLMARK CT
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City | SAGINAW
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State | MI
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Zip | 48603-2190
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Country | US
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Telephone | 989-790-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 445 S 4TH AVE
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City | SAGINAW
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State | MI
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Zip | 48601-2129
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Country | US
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Telephone | 989-752-6799
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | B 164108067648
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License Number State | MI
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