Provider Demographics
NPI:1457625956
Name:ERIKA S CARPENTER LLC
Entity Type:Organization
Organization Name:ERIKA S CARPENTER LLC
Other - Org Name:ERIKA S CARPENTER LISW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-803-4719
Mailing Address - Street 1:PO BOX 4667
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87196-4667
Mailing Address - Country:US
Mailing Address - Phone:505-803-4719
Mailing Address - Fax:505-268-2508
Practice Address - Street 1:3214 PURDUE PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2124
Practice Address - Country:US
Practice Address - Phone:505-803-4719
Practice Address - Fax:505-268-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-3452251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health