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General NPI Number Information
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NPI Number | 1740615228
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Entity Type | Individual
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Provider Name | MR. JAMES CARROLL
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Gender | Male
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 218 N 23RD ST
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City | COEUR D ALENE
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State | ID
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Zip | 83814-5411
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Country | US
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Telephone | 208-664-3300
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Fax | 208-667-3154
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Provider Business Mailing Address
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Address Line | 218 N 23RD STREET
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City | COEUR D' ALENE
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State | ID
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Zip | 83814
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Country | US
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Telephone | 208-664-3300
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Fax | 208-667-3154
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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 | JC22712
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License Number State | OR
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