Provider Demographics
NPI:1316377401
Name:WARREN, CHARLOTTE ELIZABETH (LCSA)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCSA
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ELIZABETH
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:1309 TATUM DR # DT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4314
Practice Address - Country:US
Practice Address - Phone:252-672-8742
Practice Address - Fax:252-752-0074
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0099211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical