Provider Demographics
NPI:1841579331
Name:CARPENTER, GAYDEN FISHER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAYDEN
Middle Name:FISHER
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13509
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-3509
Mailing Address - Country:US
Mailing Address - Phone:601-956-4816
Mailing Address - Fax:601-956-4817
Practice Address - Street 1:5760 I 55 N
Practice Address - Street 2:SUITE 450
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2651
Practice Address - Country:US
Practice Address - Phone:601-956-4816
Practice Address - Fax:601-956-4817
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC63541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical