Provider Demographics
NPI:1679123384
Name:CARROLL, MCCRAE PAXTON (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MCCRAE
Middle Name:PAXTON
Last Name:CARROLL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MCCRAE
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:108 CENTRAL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3079
Mailing Address - Country:US
Mailing Address - Phone:803-450-6479
Mailing Address - Fax:843-604-8171
Practice Address - Street 1:108 CENTRAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3079
Practice Address - Country:US
Practice Address - Phone:803-450-6479
Practice Address - Fax:843-604-8171
Is Sole Proprietor?:No
Enumeration Date:2019-09-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC9598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)