Provider Demographics
NPI:1427593318
Name:CARPENTER, CYNTHIA RENAE (LICSW-PIP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA RENAE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LICSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WESTMAN CIR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-4505
Mailing Address - Country:US
Mailing Address - Phone:334-830-9999
Mailing Address - Fax:
Practice Address - Street 1:90 WESTMAN CIR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-4505
Practice Address - Country:US
Practice Address - Phone:334-830-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1385C1041C0700X
AL0449-1385C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical