Individual
DALLAS RAY CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDP
Contact information
Practice address
260 FLYAWAY RD, CASTLE ROCK, WA 98611-9128
(360) 431-1929
Mailing address
PO BOX 2562, LONGVIEW, WA 98632-8607
(360) 431-1929
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60112671
WA
Other
Enumeration date
04/14/2010
Last updated
04/17/2014
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