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General NPI Number Information
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NPI Number | 1558800136
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Entity Type | Individual
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Provider Name | CHERLEIGH CARPENTER EDD, LICSW, LADC, MH
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Gender | Female
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 3333 N 4TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55412-2615
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Country | US
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Telephone | 612-767-8671
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Fax | 612-827-1215
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Provider Business Mailing Address
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Address Line | 5500 NICOLLET AVE UNIT 19321
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-1991
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Country | US
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Telephone | 612-767-8671
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Fax | 612-827-1215
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 390200000X
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27427
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | SEE-103TC2200X
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 307009
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License Number State | MN
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