Individual
REBECCA MARIE CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4090 W STATE ST STE 106, BOISE, ID 83703-4450
(209) 297-8227
Mailing address
4090 W STATE ST STE 106, BOISE, ID 83703-4450
(208) 297-8227
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
9288
ID
Other
Enumeration date
02/13/2023
Last updated
02/12/2024
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