Provider Demographics
NPI:1033594262
Name:CARPENTER, KRISTIN (LPCC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5643
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:1426 CENTER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1214
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-456-8128
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health