Provider Demographics
NPI:1073521456
Name:STAMPER, CARLETON CONRAD (THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:CARLETON
Middle Name:CONRAD
Last Name:STAMPER
Suffix:
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAMES H. QUILLEN VAMC
Mailing Address - Street 2:CORNER OF SIDNEY & LAMONT
Mailing Address - City:MT. HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3447
Practice Address - Street 1:JAMES H. QUILLEN VAMC
Practice Address - Street 2:CORNER OF SIDNEY & LAMONT
Practice Address - City:MT. HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3447
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INB5726101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)