Provider Demographics
NPI:1225589765
Name:CARROLL, KIMBERLY (MA, LADC, LPCC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 4TH AVE S
Mailing Address - Street 2:STE 5010 PMB 91823
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1053
Mailing Address - Country:US
Mailing Address - Phone:218-214-6096
Mailing Address - Fax:
Practice Address - Street 1:310 4TH AVE S
Practice Address - Street 2:STE 5010 PMB 91823
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1053
Practice Address - Country:US
Practice Address - Phone:218-214-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304598101YA0400X
MNCC01739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)