Provider Demographics
NPI:1548666795
Name:CARROLL, COURTNEY C (LPCC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:C
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2004
Mailing Address - Country:US
Mailing Address - Phone:513-290-8471
Mailing Address - Fax:
Practice Address - Street 1:520 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2004
Practice Address - Country:US
Practice Address - Phone:513-290-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2024-07-30
Deactivation Date:2018-09-14
Deactivation Code:
Reactivation Date:2018-09-25
Provider Licenses
StateLicense IDTaxonomies
OH2404557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty