Provider Demographics
NPI:1861812307
Name:BRILL, CAROL HAMILTON (LPC, NCC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:HAMILTON
Last Name:BRILL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 MARY EVE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6014
Mailing Address - Country:US
Mailing Address - Phone:318-678-9075
Mailing Address - Fax:
Practice Address - Street 1:820 JORDAN ST
Practice Address - Street 2:SUITE 510-C
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4518
Practice Address - Country:US
Practice Address - Phone:318-678-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional