Provider Demographics
NPI:1619275724
Name:CARPENTER, DAVID ALFRED (NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALFRED
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 SAINT ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7243
Mailing Address - Country:US
Mailing Address - Phone:662-212-3587
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:100 COURT ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-3900
Practice Address - Country:US
Practice Address - Phone:662-212-3587
Practice Address - Fax:662-620-7106
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health