Individual
AMANDA R CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1515 DOCTORS DR STE 4, BOSSIER CITY, LA 71111
(318) 703-6200
Mailing address
1515 DOCTORS DR STE 4, BOSSIER CITY, LA 71111-3321
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11022
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215301833
—
LA
Enumeration date
11/19/2015
Last updated
06/02/2018
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