Provider Demographics
NPI:1588661441
Name:CARPENTER, CAROLYN MARAK (MSW, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:MARAK
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BRAGG BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4289
Mailing Address - Country:US
Mailing Address - Phone:910-323-1065
Mailing Address - Fax:910-323-1144
Practice Address - Street 1:1500 BRAGG BLVD
Practice Address - Street 2:STE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4289
Practice Address - Country:US
Practice Address - Phone:910-323-1065
Practice Address - Fax:910-323-1144
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 148651041C0700X
NCC0003661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002227Medicaid
2867397Medicare ID - Type Unspecified