Provider Demographics
NPI:1932658390
Name:CARPENTER, TAMRA (LMFTA)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:TAMRA
Other - Middle Name:ENGLAND
Other - Last Name:WUSSOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3720 CEDARBARK DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3731
Mailing Address - Country:US
Mailing Address - Phone:704-909-9786
Mailing Address - Fax:
Practice Address - Street 1:3720 CEDARBARK DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3731
Practice Address - Country:US
Practice Address - Phone:704-909-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11058A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist