Provider Demographics
NPI:1881991081
Name:CARPENTER, DOROTHY VIRGINIA (LPC)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:VIRGINIA
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-5514
Mailing Address - Country:US
Mailing Address - Phone:229-890-2288
Mailing Address - Fax:229-890-2289
Practice Address - Street 1:600 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5514
Practice Address - Country:US
Practice Address - Phone:229-890-2288
Practice Address - Fax:229-890-2289
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional