Individual
LARISSA MARA CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
509 WHEAT AVE, BAINBRIDGE, GA 39819-4321
(229) 416-4421
Mailing address
509 WHEAT AVE, BAINBRIDGE, GA 39819-4321
(229) 416-4421
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW005481
GA
Other
Enumeration date
09/10/2015
Last updated
12/21/2015
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