Provider Demographics
NPI:1467628768
Name:SNYDER, CHARLES JAMES (LMSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JAMES
Last Name:SNYDER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3010
Mailing Address - Country:US
Mailing Address - Phone:313-561-1098
Mailing Address - Fax:313-561-0709
Practice Address - Street 1:2312 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3010
Practice Address - Country:US
Practice Address - Phone:313-561-1098
Practice Address - Fax:313-561-0709
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health