Individual
TYHEARIA CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5501 OLD YORK RD STE 1, PHILADELPHIA, PA 19141-3098
(215) 456-6666
Mailing address
3014 EUCLID AVE, PHILADELPHIA, PA 19121-1813
(267) 600-0943
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11340
PA
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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