Provider Demographics
NPI:1174230643
Name:CHARLIE CHARLTON, LICSW, LLC
Entity type:Organization
Organization Name:CHARLIE CHARLTON, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:CHARLIE
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:207-975-2349
Mailing Address - Street 1:18 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:ME
Mailing Address - Zip Code:04563-3255
Mailing Address - Country:US
Mailing Address - Phone:207-975-2349
Mailing Address - Fax:207-975-2349
Practice Address - Street 1:18 LOVERS LN
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:ME
Practice Address - Zip Code:04563-3255
Practice Address - Country:US
Practice Address - Phone:207-975-2349
Practice Address - Fax:207-975-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty