Provider Demographics
NPI:1225267578
Name:STAGGS, CHARLOTTE MARICIA (EDD)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:MARICIA
Last Name:STAGGS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 23
Mailing Address - Street 2:
Mailing Address - City:NUNNELLY
Mailing Address - State:TN
Mailing Address - Zip Code:37137
Mailing Address - Country:US
Mailing Address - Phone:931-623-0717
Mailing Address - Fax:
Practice Address - Street 1:820 HIGHWAY 100
Practice Address - Street 2:#3
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033
Practice Address - Country:US
Practice Address - Phone:931-623-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health