1679123384 NPI number — MR. MCCRAE PAXTON CARROLL MA, LPC

Table of content: MR. MCCRAE PAXTON CARROLL MA, LPC (NPI 1679123384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679123384 NPI number — MR. MCCRAE PAXTON CARROLL MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARROLL
Provider First Name:
MCCRAE
Provider Middle Name:
PAXTON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARROLL
Provider Other First Name:
MCCRAE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679123384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 CENTRAL AVE STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOOSE CREEK
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29445-3079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-450-6479
Provider Business Mailing Address Fax Number:
843-604-8171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 CENTRAL AVE STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOOSE CREEK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29445-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-450-6479
Provider Business Practice Location Address Fax Number:
843-604-8171
Provider Enumeration Date:
09/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 9598 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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