Provider Demographics
NPI:1952159428
Name:CARPENTER, ALECIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 E SOUTHERN AVE STE 1052
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6205
Mailing Address - Country:US
Mailing Address - Phone:480-250-7057
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 1052
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6205
Practice Address - Country:US
Practice Address - Phone:480-250-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-23441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical