Provider Demographics
NPI:1396019774
Name:CARLIE, CHARLENE (MHPP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:CARLIE
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 MILL RD
Mailing Address - Street 2:MAPLE DORM#7
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-8511
Mailing Address - Country:US
Mailing Address - Phone:479-705-0430
Mailing Address - Fax:479-705-0430
Practice Address - Street 1:522 MILLS RD.
Practice Address - Street 2:MAPLE DORM#7
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830
Practice Address - Country:US
Practice Address - Phone:479-705-0430
Practice Address - Fax:479-705-0430
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator