Provider Demographics
NPI:1033517552
Name:GREEN, CHARITY (MSW)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CHARITY
Other - Middle Name:GRACE
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:MABSCOTT
Mailing Address - State:WV
Mailing Address - Zip Code:25871-0543
Mailing Address - Country:US
Mailing Address - Phone:304-731-5263
Mailing Address - Fax:
Practice Address - Street 1:200 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6444
Practice Address - Country:US
Practice Address - Phone:304-255-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker