Provider Demographics
NPI:1538251392
Name:CARROLL, LISA YVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:YVONNE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:YVONNE
Other - Last Name:BULLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2731 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5235
Mailing Address - Country:US
Mailing Address - Phone:205-349-3250
Mailing Address - Fax:205-752-1517
Practice Address - Street 1:2731 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5235
Practice Address - Country:US
Practice Address - Phone:205-349-3250
Practice Address - Fax:205-752-1517
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2467C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical