Provider Demographics
NPI:1407588494
Name:HADDIX, CHARLES ANDERSON JR
Entity Type:Individual
Prefix:MS
First Name:CHARLES
Middle Name:ANDERSON
Last Name:HADDIX
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 OAKLEAF DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3541
Mailing Address - Country:US
Mailing Address - Phone:470-606-6982
Mailing Address - Fax:
Practice Address - Street 1:741 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3541
Practice Address - Country:US
Practice Address - Phone:470-606-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty