Provider Demographics
NPI:1720823032
Name:CARROLL, ALEXA RAE (LMHC)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CAMINITO MONTANO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1753
Mailing Address - Country:US
Mailing Address - Phone:248-877-2796
Mailing Address - Fax:
Practice Address - Street 1:103 CAMINITO MONTANO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1753
Practice Address - Country:US
Practice Address - Phone:248-877-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health