Provider Demographics
NPI:1386294528
Name:CARROLL, KRISTI (LICDC, LPC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-9009
Mailing Address - Country:US
Mailing Address - Phone:740-245-3051
Mailing Address - Fax:
Practice Address - Street 1:11821 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-9009
Practice Address - Country:US
Practice Address - Phone:740-245-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162235101YA0400X
OHE.2404007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145313Medicaid