Provider Demographics
NPI:1962713578
Name:CARPENTER, ANGEL J L (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:J L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SAINT LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2730
Mailing Address - Country:US
Mailing Address - Phone:228-469-0094
Mailing Address - Fax:
Practice Address - Street 1:538 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SAINT LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-2730
Practice Address - Country:US
Practice Address - Phone:228-469-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS42-688103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical