Provider Demographics
NPI:1588260137
Name:CARROLL, SYDNEY GABRIELLE
Entity type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:GABRIELLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 FOX HUNT DR APT H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7131
Mailing Address - Country:US
Mailing Address - Phone:336-880-1864
Mailing Address - Fax:
Practice Address - Street 1:5247 FOX HUNT DR APT H
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7131
Practice Address - Country:US
Practice Address - Phone:336-880-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health