Basic Information
| Provider Information | |||||||||
| NPI: | 1104030725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | ELLIOTT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1309 S. LINDEN RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106301152 | ||||||||
| FaxNumber: | 8106309107 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 S LINDEN RD STE C | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106301152 | ||||||||
| FaxNumber: | 8106309107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401005393 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.