Provider Demographics
NPI:1124766308
Name:CARROLL, AMBERLE DAWN (BA)
Entity type:Individual
Prefix:
First Name:AMBERLE
Middle Name:DAWN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23380 N 61ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5748
Mailing Address - Country:US
Mailing Address - Phone:602-358-7073
Mailing Address - Fax:888-927-0409
Practice Address - Street 1:14040 N CAVE CREEK RD # 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6117
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:888-927-0409
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health