Provider Demographics
NPI:1467692913
Name:SUGAR, CHARLES BRIAN (LPC, MHSP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BRIAN
Last Name:SUGAR
Suffix:
Gender:M
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 POWELL PL
Mailing Address - Street 2:SUITE 129
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7522
Mailing Address - Country:US
Mailing Address - Phone:615-369-0650
Mailing Address - Fax:615-523-1645
Practice Address - Street 1:205 POWELL PL
Practice Address - Street 2:SUITE 129
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7522
Practice Address - Country:US
Practice Address - Phone:615-369-0650
Practice Address - Fax:615-523-1645
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor