Individual
MARIANNE ROBERTS CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LADC
Contact information
Practice address
387 TUCKIE RD, D, NORTH WINDHAM, CT 06256-1355
(860) 423-4279
(860) 423-4284
Mailing address
387 TUCKIE RD, D, NORTH WINDHAM, CT 06256-1355
(860) 423-4279
(860) 423-4284
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000055
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004255007
—
CT
01
—
165927
VALUE OPTIONS
—
01
—
199589
MHN
CT
01
—
300000055CT01
ANTHEM
CT
01
—
P2633664
OXFORD
—
Enumeration date
09/21/2006
Last updated
10/01/2014
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