Healthcare Provider Details

I. General information

NPI: 1053966754
Provider Name (Legal Business Name): DARLA NICOLE CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 JADWIN AVE STE 6
RICHLAND WA
99352-4217
US

IV. Provider business mailing address

719 JADWIN AVE STE 33
RICHLAND WA
99352-4217
US

V. Phone/Fax

Practice location:
  • Phone: 509-780-6813
  • Fax:
Mailing address:
  • Phone: 509-579-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61002624
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: