Provider Demographics
NPI:1750625653
Name:CARPENTER, GLORIA J O (PHD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:J O
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5104
Mailing Address - Country:US
Mailing Address - Phone:513-461-1447
Mailing Address - Fax:703-528-8055
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:PLAZA LEVEL SUITE 3
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2486
Practice Address - Country:US
Practice Address - Phone:513-278-2631
Practice Address - Fax:703-528-8055
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004581103TC0700X
KY1554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical