Provider Demographics
NPI:1215040902
Name:ENGLAND, CHARLOTTE JENNIFER (MEDLPC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:JENNIFER
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:MEDLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 STATE HIGHWAY 80 S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-7534
Mailing Address - Country:US
Mailing Address - Phone:828-675-9271
Mailing Address - Fax:
Practice Address - Street 1:5109 STATE HIGHWAY 80 S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-7534
Practice Address - Country:US
Practice Address - Phone:828-675-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1098XOtherBLUECROSS/BLUESHILED
NC6102162Medicaid