Provider Demographics
NPI:1881300069
Name:CARPENTER, LISA D (LMFT-A)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 PEPPERMILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-5993
Mailing Address - Country:US
Mailing Address - Phone:602-541-4042
Mailing Address - Fax:
Practice Address - Street 1:1365 WESTGATE CENTER DR STE L1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3106
Practice Address - Country:US
Practice Address - Phone:336-448-4451
Practice Address - Fax:336-450-1884
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12489A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist