Provider Demographics
NPI:1275145526
Name:VON PRESLEY, CHARLES BERNARD (CHAPLAIN, STUDENT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BERNARD
Last Name:VON PRESLEY
Suffix:
Gender:M
Credentials:CHAPLAIN, STUDENT
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:E
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 CATTLEMEN RD UNIT 2102
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6293
Mailing Address - Country:US
Mailing Address - Phone:914-486-2612
Mailing Address - Fax:
Practice Address - Street 1:6497 PARKLAND DR STE D
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-4097
Practice Address - Country:US
Practice Address - Phone:914-486-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor