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General NPI Number Information
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NPI Number | 1255679023
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Entity Type | Individual
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Provider Name | TEENA CARPENTER M.S, LPC, MAC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 303 W COURT ST
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City | JANESVILLE
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State | WI
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Zip | 53548-3811
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Country | US
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Telephone | 843-601-2496
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Fax |
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Provider Business Mailing Address
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Address Line | 406 BETZER RD APT 7
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City | DELAVAN
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State | WI
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Zip | 53115-4301
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Country | US
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Telephone | 843-601-2496
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Fax | 608-741-5219
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1105271
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License Number State | SC
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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 |
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License Number State |
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