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NPI Code Detail

MEDICARE: MIA SHAVON AGELU CARROLL

MEDICARE: MIA SHAVON AGELU CARROLL
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1821929902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIA SHAVON AGELU CARROLL
Provider Business Mailing Address
First Line : 2901 MAYFIELD RD APT 5213
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-7582
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 E DEBBIE LN
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-2924
Country : US
Telephone Number : 972-333-8173
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ MIA SHAVON AGELU CARROLL ” Practice Location

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