MEDICARE: ELEANOR CARROLL PHD

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	103TC0700X	Clinical Psychologist	2774	NC
2	103T00000X	Psychologist	2774	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972656999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR CARROLL PHD

Provider Business Mailing Address
First Line	:	941 FOXBOROUGH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5765
Country	:	US
Telephone Number	:	980-253-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 FOXBOROUGH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5765
Country	:	US
Telephone Number	:	980-253-6150
Fax Number	:	704-598-2490

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

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	05/19/2020

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