Provider Demographics
NPI:1902980824
Name:CARROLL, VIANA LYNNE (LSW)
Entity type:Individual
Prefix:
First Name:VIANA
Middle Name:LYNNE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1653
Mailing Address - Country:US
Mailing Address - Phone:513-892-4673
Mailing Address - Fax:513-737-1107
Practice Address - Street 1:36 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2909
Practice Address - Country:US
Practice Address - Phone:513-610-4673
Practice Address - Fax:513-737-1107
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-319111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical