Provider Demographics
NPI:1588680227
Name:SCARBOROUGH, CAROL BALL (LMFT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:BALL
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6518
Mailing Address - Country:US
Mailing Address - Phone:925-947-2159
Mailing Address - Fax:925-932-4541
Practice Address - Street 1:1415 OAKLAND BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4386
Practice Address - Country:US
Practice Address - Phone:925-947-2159
Practice Address - Fax:925-932-4541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC28707OtherLICENSE (MFT)