Provider Demographics
NPI:1295347060
Name:CARROLL, CYNDI (LADC)
Entity type:Individual
Prefix:
First Name:CYNDI
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 207TH ST N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8020
Mailing Address - Country:US
Mailing Address - Phone:651-248-7986
Mailing Address - Fax:
Practice Address - Street 1:5985 RICE CREEK PKWY STE 201
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5037
Practice Address - Country:US
Practice Address - Phone:651-348-7240
Practice Address - Fax:651-348-7265
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303287101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)