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General NPI Number Information
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NPI Number | 1609584135
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Entity Type | Individual
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Provider Name | JESSICA CARPENTER
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Gender | Female
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 3433 BRAMBLETON AVE
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City | ROANOKE
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State | VA
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Zip | 24018-6515
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Country | US
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Telephone | 804-562-6604
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Fax | 757-970-0277
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Provider Business Mailing Address
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Address Line | 6800 PARAGON PL STE 200
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City | RICHMOND
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State | VA
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Zip | 23230-1652
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Country | US
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Telephone | 804-562-6604
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Fax | 757-970-0277
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-202684
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License Number State | VA
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