Provider Demographics
NPI:1821388216
Name:CARPENTER, SHAWNMARIE
Entity Type:Individual
Prefix:MRS
First Name:SHAWNMARIE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E INTL AIRPORT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1409
Mailing Address - Country:US
Mailing Address - Phone:907-507-6382
Mailing Address - Fax:800-972-3679
Practice Address - Street 1:1205 E INTL AIRPORT RD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1409
Practice Address - Country:US
Practice Address - Phone:907-507-6382
Practice Address - Fax:800-972-3679
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16106H00000X
AK275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist