Provider Demographics
NPI:1881080836
Name:CARPENTER, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
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:PO BOX 11631
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1631
Mailing Address - Country:US
Mailing Address - Phone:865-333-0148
Mailing Address - Fax:865-521-5047
Practice Address - Street 1:4706 PAPERMILL DR STE 205
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1972
Practice Address - Country:US
Practice Address - Phone:865-333-0148
Practice Address - Fax:865-521-5047
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical