Provider Demographics
NPI:1427561950
Name:NORTHAN, CHARITY (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHARITY
Middle Name:
Last Name:NORTHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:NORTHAN-JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14050 N 83RD AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5650
Mailing Address - Country:US
Mailing Address - Phone:602-529-6102
Mailing Address - Fax:
Practice Address - Street 1:14050 N 83RD AVE STE 290
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5650
Practice Address - Country:US
Practice Address - Phone:602-529-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC18935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional