Provider Demographics
NPI:1679540413
Name:CARPENTER, LISA CAROL (LPC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:CAROL
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:302 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-3737
Mailing Address - Country:US
Mailing Address - Phone:501-229-1515
Mailing Address - Fax:888-337-2305
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-3737
Practice Address - Country:US
Practice Address - Phone:501-229-1515
Practice Address - Fax:888-337-2305
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP09070043101YP2500X
ARP0907043101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid