Provider Demographics
NPI:1407086754
Name:CHARLES, KAREN D (MSW;LCSW;C-ASWCM)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:D
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSW;LCSW;C-ASWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8849
Mailing Address - Country:US
Mailing Address - Phone:480-615-5921
Mailing Address - Fax:480-615-5921
Practice Address - Street 1:935 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8849
Practice Address - Country:US
Practice Address - Phone:480-615-5921
Practice Address - Fax:480-615-5921
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-107041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical