Provider Demographics
NPI:1235506213
Name:CARPENTER, MICHELLE L (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:BAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 E SUNBRIDGE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2853
Mailing Address - Country:US
Mailing Address - Phone:479-234-1365
Mailing Address - Fax:
Practice Address - Street 1:102 E SUNBRIDGE DR STE 10
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-234-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1502037101YM0800X
ARP1703276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health