Provider Demographics
NPI:1336928787
Name:CARPENTER, LATWAN (DR DHS QMHPA MATC)
Entity Type:Individual
Prefix:
First Name:LATWAN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DR DHS QMHPA MATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 HOLLADAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2015
Mailing Address - Country:US
Mailing Address - Phone:757-966-1270
Mailing Address - Fax:
Practice Address - Street 1:1717 HOLLADAY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2015
Practice Address - Country:US
Practice Address - Phone:757-920-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)