Provider Demographics
NPI:1356756258
Name:CARPENTER, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
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 1:413 COUNTY ROAD 750
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7919
Mailing Address - Country:US
Mailing Address - Phone:334-652-4482
Mailing Address - Fax:
Practice Address - Street 1:413 COUNTY ROAD 750
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-7919
Practice Address - Country:US
Practice Address - Phone:334-652-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst