Provider Demographics
NPI:1174791198
Name:LINDEMAN, CHARLES ATLAS (LPCC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ATLAS
Last Name:LINDEMAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1808
Mailing Address - Country:US
Mailing Address - Phone:859-757-7167
Mailing Address - Fax:
Practice Address - Street 1:34 MILLER LN
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1808
Practice Address - Country:US
Practice Address - Phone:859-878-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100269960Medicaid