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General NPI Number Information
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NPI Number | 1255571006
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Entity Type | Individual
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Provider Name | TRACY ELLEN CARPENTER SAP, SSW, CAC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 103 WHITE HORSE PIKE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1909
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Country | US
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Telephone | 856-547-5651
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Fax | 856-546-9595
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Provider Business Mailing Address
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Address Line | 103 WHITE HORSE PIKE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1909
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Country | US
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Telephone | 856-547-5651
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Fax | 856-546-9595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00331500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00331500
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License Number State | NJ
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