Provider Demographics
NPI:1194170332
Name:CARROLL, SHAWN (LPC-S)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:BAILEYTON
Mailing Address - State:AL
Mailing Address - Zip Code:35019-0143
Mailing Address - Country:US
Mailing Address - Phone:205-446-0294
Mailing Address - Fax:888-500-5517
Practice Address - Street 1:10865 US HIGHWAY 278 E STE A
Practice Address - Street 2:
Practice Address - City:HOLLY POND
Practice Address - State:AL
Practice Address - Zip Code:35083-6884
Practice Address - Country:US
Practice Address - Phone:205-446-0294
Practice Address - Fax:888-500-5517
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional