Individual
CHARLES CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMHT
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648
(601) 249-4214
(601) 249-4234
Mailing address
1701 WHITE ST, PO BOX 769, MCCOMB, MS 39648
(601) 249-4214
(601) 249-4234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018209
—
MS
Enumeration date
08/13/2018
Last updated
05/10/2021
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