Healthcare Provider Details

I. General information

NPI: 1649106592
Provider Name (Legal Business Name): CHRISTINA CARPENTER MASTER IN CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7853 GUNN HWY # 262
TAMPA FL
33626-1611
US

IV. Provider business mailing address

7853 GUNN HWY # 262
TAMPA FL
33626-1611
US

V. Phone/Fax

Practice location:
  • Phone: 813-538-6142
  • Fax:
Mailing address:
  • Phone: 813-538-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: