Provider Demographics
NPI:1407180581
Name:DABBS, CHARLOTTE SIMMS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:SIMMS
Last Name:DABBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 OAK ALLEY CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1306
Mailing Address - Country:US
Mailing Address - Phone:419-534-2468
Mailing Address - Fax:419-534-2397
Practice Address - Street 1:3454 OAK ALLEY CT
Practice Address - Street 2:SUITE 305
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1306
Practice Address - Country:US
Practice Address - Phone:419-534-2468
Practice Address - Fax:419-534-2397
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6489103T00000X, 103TC1900X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11562790OtherCAQH