Provider Demographics
NPI:1134405376
Name:CARPENTER, BRENNA (LCMHCS)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JACKSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2646
Mailing Address - Country:US
Mailing Address - Phone:252-676-6636
Mailing Address - Fax:252-674-1165
Practice Address - Street 1:600 JACKSON ST STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2646
Practice Address - Country:US
Practice Address - Phone:252-308-0744
Practice Address - Fax:252-308-0092
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS11314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health