Provider Demographics
NPI:1598488231
Name:CARROLL, JIANA RAE
Entity type:Individual
Prefix:
First Name:JIANA
Middle Name:RAE
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 1:4748 ASHER HTS APT 302
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-6413
Mailing Address - Country:US
Mailing Address - Phone:719-474-9334
Mailing Address - Fax:
Practice Address - Street 1:1233 LAKE PLAZA DR STE D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3567
Practice Address - Country:US
Practice Address - Phone:719-375-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician