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Provider Information for 1437608825


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Ms. ANGELA CARROLL MSW, LAC


Sex: Female

NPI: 1437608825
Last Updated: 2016-09-26
Certification Date:

Details

NameValue
NPI1437608825
Enumeration Date2016-09-26
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 115 4TH ST S
GREAT FALLS, MT 59401-3618
United States

Phone: 406-268-9724 | Fax:
 
Primary Practice Address 115 4TH ST S
GREAT FALLS, MT 59401-3618
United States

Phone: 406-268-9724 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)MTBBH-LAC-LIC-16772
Yes 1041C0700X - Social Worker - ClinicalMTBBH-SWLC-LIC-17551