Provider Demographics
NPI:1174775084
Name:UNDERWOOD, CHARLES K JR (PHD LMHC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:UNDERWOOD
Suffix:JR
Gender:M
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:GOLDENROD
Mailing Address - State:FL
Mailing Address - Zip Code:32733-0825
Mailing Address - Country:US
Mailing Address - Phone:407-342-7165
Mailing Address - Fax:407-977-0931
Practice Address - Street 1:1047 SHINNECOCK HILLS DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5809
Practice Address - Country:US
Practice Address - Phone:407-342-7165
Practice Address - Fax:407-977-0931
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ024YOtherBLUE CROSS BLUE SHIELD