Provider Demographics
NPI:1083740989
Name:ADCOCK, CHARLES R (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 RADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3512
Mailing Address - Country:US
Mailing Address - Phone:804-354-1996
Mailing Address - Fax:804-354-5516
Practice Address - Street 1:4906 RADFORD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3512
Practice Address - Country:US
Practice Address - Phone:804-354-1996
Practice Address - Fax:804-354-5516
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA168467000OtherMAGELLAN MIS
VA303526OtherANTHEM
VA168467000OtherMAGELLAN
VA84904OtherOPTIMA BEHAVIORAL HEALTH
861112647OtherUBH
VA145129OtherANTHEM PROV #
VAN06B91OtherEMPIRE PROV #
VA5608429OtherAETNA PROV #
VA102045OtherVALUE OPTION PROV #
VA1019476OtherCIGNA PROV #