Provider Demographics
NPI:1740004423
Name:CARPENTER, VICKIE LYNN
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
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:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:SEAGROVE
Mailing Address - State:NC
Mailing Address - Zip Code:27341-0499
Mailing Address - Country:US
Mailing Address - Phone:919-669-9160
Mailing Address - Fax:
Practice Address - Street 1:1822 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-3381
Practice Address - Country:US
Practice Address - Phone:336-365-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS11608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health