1619275724 NPI number — MR. DAVID ALFRED CARPENTER NCC, LPC

Table of content: MR. DAVID ALFRED CARPENTER NCC, LPC (NPI 1619275724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619275724 NPI number — MR. DAVID ALFRED CARPENTER NCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
DAVID
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NCC, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619275724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4028 SAINT ANDREWS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORINTH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38834-7243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-212-3587
Provider Business Mailing Address Fax Number:
662-620-7106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38804-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-212-3587
Provider Business Practice Location Address Fax Number:
662-620-7106
Provider Enumeration Date:
03/14/2011

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: 101YM0800X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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