Provider Demographics
NPI:1104143650
Name:CORDIER-CARPENTER, CAROL S
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:CORDIER-CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:S
Other - Last Name:CORDIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:131 ROXANNE CT
Mailing Address - Street 2:APT. 1
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-1958
Mailing Address - Country:US
Mailing Address - Phone:707-758-4854
Mailing Address - Fax:
Practice Address - Street 1:6707 EMBARCADERO DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3382
Practice Address - Country:US
Practice Address - Phone:209-956-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist