Provider Demographics
NPI:1164930673
Name:MCDONALD, CHARLENE BROWN (LPCA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:BROWN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 S FORT THOMAS AVE UNIT 75289
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-7512
Mailing Address - Country:US
Mailing Address - Phone:513-580-7390
Mailing Address - Fax:
Practice Address - Street 1:24 S. FT. THOMAS AVE. UNIT 75289
Practice Address - Street 2:
Practice Address - City:FT. THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-0289
Practice Address - Country:US
Practice Address - Phone:513-580-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY246724101YP2500X
KY282937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional