MEDICARE: MS. IRENE G CARROLL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3444	NC

General Provider Information

NPI Number	:	1659315141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE G CARROLL LPC

Provider Business Mailing Address
First Line	:	2237 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5922
Country	:	US
Telephone Number	:	704-779-0372
Fax Number	:	704-358-0876

Provider Business Practice Location Address
First Line	:	2237 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5922
Country	:	US
Telephone Number	:	704-779-0372
Fax Number	:	704-358-0876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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