Provider Demographics
NPI:1235943275
Name:CARPENTER, THOMAS JAMES (NCCPSS, BS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:NCCPSS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-8678
Mailing Address - Country:US
Mailing Address - Phone:336-483-7973
Mailing Address - Fax:
Practice Address - Street 1:272 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-8678
Practice Address - Country:US
Practice Address - Phone:336-483-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-4806-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist