Provider Demographics
NPI:1326650409
Name:IRVING, CHARLOTTE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:IRVING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 PASEO DEL PRADO APT 9
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1547
Mailing Address - Country:US
Mailing Address - Phone:914-391-2896
Mailing Address - Fax:
Practice Address - Street 1:3850 PASEO DEL PRADO APT 9
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1547
Practice Address - Country:US
Practice Address - Phone:914-391-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0109732101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty