Provider Demographics
NPI:1093213472
Name:CHARALAMBOPOULOS, BILL (LCDC)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:
Last Name:CHARALAMBOPOULOS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 N COLLINS BLVD STE 601A
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2645
Mailing Address - Country:US
Mailing Address - Phone:214-597-7574
Mailing Address - Fax:
Practice Address - Street 1:2011 N COLLINS BLVD STE 601A
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2645
Practice Address - Country:US
Practice Address - Phone:214-597-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14259101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)