Provider Demographics
NPI:1386468429
Name:CARROLL, DYLAN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 CANOPY TRL
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4020
Mailing Address - Country:US
Mailing Address - Phone:601-622-1094
Mailing Address - Fax:
Practice Address - Street 1:500 CENTURY PARK S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3946
Practice Address - Country:US
Practice Address - Phone:205-991-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst