Provider Demographics
NPI:1861615643
Name:SMITH CARROLL, CHERYL NOREEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:NOREEN
Last Name:SMITH CARROLL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0838
Mailing Address - Country:US
Mailing Address - Phone:209-602-5393
Mailing Address - Fax:209-523-1429
Practice Address - Street 1:1015 12TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0838
Practice Address - Country:US
Practice Address - Phone:209-602-5393
Practice Address - Fax:209-523-1429
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist