Basic Information
| Provider Information | |||||||||
| NPI: | 1083828172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | GREENWALT | ||||||||
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| Credential: | MSW, LMSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 W WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497072929 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2390 MITCHELL PARK DR | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801069517 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.