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General NPI Number Information
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NPI Number | 1750625653
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Entity Type | Individual
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Provider Name | GLORIA J. O. CARPENTER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 4141 N HENDERSON RD PLAZA LEVEL SUITE 3
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City | ARLINGTON
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State | VA
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Zip | 22203-2486
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Country | US
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Telephone | 513-278-2631
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Fax | 703-528-8055
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Provider Business Mailing Address
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Address Line | 4006 WOODLAND DR
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City | FAIRFAX
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State | VA
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Zip | 22030-5104
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Country | US
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Telephone | 513-461-1447
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Fax | 703-528-8055
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004581
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1554
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License Number State | KY
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