Provider Demographics
NPI:1063684215
Name:PETILLO, CAROL V (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:V
Last Name:PETILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2425
Mailing Address - Country:US
Mailing Address - Phone:864-655-8300
Mailing Address - Fax:864-603-1555
Practice Address - Street 1:4318 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2425
Practice Address - Country:US
Practice Address - Phone:864-655-8300
Practice Address - Fax:864-603-1555
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3886231H00000X
NC7312231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30111366OtherSELECT HEALTH OF SOUTH CAROLINA
NC7413356Medicaid
NCP01450607OtherRAILROAD MEDICARE
NC5939044OtherCIGNA
SCP01044436OtherRAILROAD MEDICARE
NC9873230OtherAETNA
770333OtherWELLCARE
SCSA1085Medicaid
NC1618ROtherBCBSNC
SCSA1085Medicaid