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General NPI Number Information
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NPI Number | 1669290276
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Entity Type | Individual
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Provider Name | YVONNE CARPENTER
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1400 E 55TH ST # A
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City | CLEVELAND
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State | OH
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Zip | 44103-1304
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Country | US
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Telephone | 216-391-6672
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Fax | 216-391-4633
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Provider Business Mailing Address
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Address Line | 631 LEE RD BLDG C
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City | BEDFORD
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State | OH
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Zip | 44146-3496
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Country | US
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Telephone | 404-645-2413
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Fax |
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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 | 190140
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License Number State | OH
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