Provider Demographics
NPI:1043752587
Name:MOLDEN, CHARKELA JENEA GASTON (EDS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CHARKELA
Middle Name:JENEA GASTON
Last Name:MOLDEN
Suffix:
Gender:F
Credentials:EDS, LPC, NCC
Other - Prefix:MS
Other - First Name:CHARKELA
Other - Middle Name:JENEA
Other - Last Name:GASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, LPC, NCC
Mailing Address - Street 1:100 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-5145
Mailing Address - Country:US
Mailing Address - Phone:478-471-2985
Mailing Address - Fax:
Practice Address - Street 1:100 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-5145
Practice Address - Country:US
Practice Address - Phone:478-471-2985
Practice Address - Fax:478-471-5730
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005189101YP2500X
GALPC009996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional