Provider Demographics
NPI:1063746097
Name:WOODALL CARROLL, DEBORAH A (LPCC-S)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:WOODALL CARROLL
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:WOODALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4055 EXECUTIVE PK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4019
Mailing Address - Country:US
Mailing Address - Phone:513-469-6226
Mailing Address - Fax:513-469-6277
Practice Address - Street 1:4055 EXECUTIVE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4019
Practice Address - Country:US
Practice Address - Phone:513-469-6226
Practice Address - Fax:513-469-6277
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional