Provider Demographics
NPI:1285091538
Name:CARPENTER, CYNTHIA (CDCA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1329
Mailing Address - Country:US
Mailing Address - Phone:740-374-8730
Mailing Address - Fax:740-374-8767
Practice Address - Street 1:1338 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1329
Practice Address - Country:US
Practice Address - Phone:740-374-8730
Practice Address - Fax:740-374-8767
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150334101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH150334OtherCDCA