Provider Demographics
NPI:1992981781
Name:CARPENTER, SHANAE LUCINDA (LPCC)
Entity type:Individual
Prefix:MRS
First Name:SHANAE
Middle Name:LUCINDA
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOGLE ST., SUITE 102
Mailing Address - Street 2:INTRUST HEALTHCARE
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-676-0638
Mailing Address - Fax:606-679-1889
Practice Address - Street 1:401 BOGLE ST., SUITE 102
Practice Address - Street 2:INTRUST HEALTHCARE
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-676-0638
Practice Address - Fax:606-679-1889
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health