Provider Demographics
NPI:1083103626
Name:BARTON COOMBS, CHARLOTTE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:BARTON COOMBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 13TH ST STE 2540
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1305
Mailing Address - Country:US
Mailing Address - Phone:812-372-3745
Mailing Address - Fax:812-372-5367
Practice Address - Street 1:1531 13TH ST STE 2540
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1305
Practice Address - Country:US
Practice Address - Phone:812-372-3745
Practice Address - Fax:812-372-5367
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010449A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300080359Medicaid