Provider Demographics
NPI:1194160366
Name:CARROLL, CRYSTAL MARIE (BA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 SOMERVILLE RD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4305
Mailing Address - Country:US
Mailing Address - Phone:256-260-7361
Mailing Address - Fax:256-341-0747
Practice Address - Street 1:4110 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1644
Practice Address - Country:US
Practice Address - Phone:256-260-7361
Practice Address - Fax:256-341-0747
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health