Provider Demographics
NPI:1477958148
Name:COX, CHARLES MATTHEW (LCASA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MATTHEW
Last Name:COX
Suffix:
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LYNNDALE CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5443
Mailing Address - Country:US
Mailing Address - Phone:252-353-8001
Mailing Address - Fax:
Practice Address - Street 1:2269 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2841
Practice Address - Country:US
Practice Address - Phone:252-439-0700
Practice Address - Fax:252-439-0900
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20393101YA0400X
NC11224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)