| Carpenter House Inc. | |
|
4400 E Highway 20 Suite 306 Niceville FL 32578-8779 | |
| (850) 897-7810 | |
| (850) 897-0032 |
| Full Name | Carpenter House Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 4400 E Highway 20, Niceville, Florida |
| Authorized Official Name and Position | Kathlyn C White (PRESIDENT) |
| Authorized Official Contact | 8508977810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carpenter House Inc. Po Box 5383 Niceville FL 32578-5383 Ph: (850) 897-7810 | Carpenter House Inc. 4400 E Highway 20 Suite 306 Niceville FL 32578-8779 Ph: (850) 897-7810 |
| NPI Number | 1982069480 |
|---|---|
| Provider Enumeration Date | 12/28/2015 |
| Last Update Date | 12/29/2015 |
| Medicare PECOS PAC ID | 7618225749 |
|---|---|
| Medicare Enrollment ID | O20180807001555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982069480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Ruby Lisa Hawkins-jack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619233566 PECOS PAC ID: 5395134555 Enrollment ID: I20211110001533 |
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