Provider Demographics
NPI:1316660335
Name:CARPENTER, SCOTTY (PHD, LCMHCA)
Entity type:Individual
Prefix:DR
First Name:SCOTTY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PHD, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 WATERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-3070
Mailing Address - Country:US
Mailing Address - Phone:336-465-6346
Mailing Address - Fax:
Practice Address - Street 1:379 S COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5714
Practice Address - Country:US
Practice Address - Phone:336-860-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health