Healthcare Provider Details

I. General information

NPI: 1881626455
Provider Name (Legal Business Name): LINDALYN CARPENTER PHYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PISGAH CHURCH RD STE 100
GREENSBORO NC
27455-3303
US

IV. Provider business mailing address

PO BOX 13605
GREENSBORO NC
27415-3605
US

V. Phone/Fax

Practice location:
  • Phone: 336-288-6165
  • Fax:
Mailing address:
  • Phone: 336-547-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: