Provider Demographics
NPI:1497911895
Name:CARPENTER COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:CARPENTER COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-887-6710
Mailing Address - Street 1:1042 N MILFORD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-5107
Mailing Address - Country:US
Mailing Address - Phone:248-887-6710
Mailing Address - Fax:248-887-6830
Practice Address - Street 1:1042 N MILFORD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-5107
Practice Address - Country:US
Practice Address - Phone:248-887-6710
Practice Address - Fax:248-887-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011772251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health