Provider Demographics
NPI:1508316357
Name:CARPENTER, TRACEY (LB BCBA)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LB BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FRIENDLY LN
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2663
Mailing Address - Country:US
Mailing Address - Phone:910-507-0749
Mailing Address - Fax:910-518-5227
Practice Address - Street 1:3331 HERITAGE TRADE DR STE 110
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4346
Practice Address - Country:US
Practice Address - Phone:910-507-0749
Practice Address - Fax:910-518-5227
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22922103K00000X
NC114103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst