| Doctor Name: | KIMBERLY CARPENTER |
| NPI Number: | 1053785915 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCA |
| License Number: | A11798 |
| Business Practice Address: | 25 Ohana Dr Nw Supply, NC - 284624222 |
| Business Phone Number: | 9108804813 |
| Business Fax Number: | |
| Mailing Address: | 25 Ohana Dr Nw, SUPPLY |
| State: | NC |
| Postal Code: | 284624222 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/16/2015 |
| NPI Last Update Date: | 11/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | A11798 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |