Raquel Nichole Carroll
Individual provider Active NPI Counselor · Picayune, MS
NPI 1104456946 · NPPES record last updated Jan 21, 2020
Key facts
- NPI
- 1104456946
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 2007 Wildwood Rd
Picayune, MS 39466-2178 - Phone
- (769) 926-2657
- NPI assigned
- Jan 21, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
2007 Wildwood Rd
Picayune, MS 39466-2178
Mailing address
860 E River PL Ste 100
Jackson, MS 39202-3442
Other providers in Picayune, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.