Provider Demographics
NPI:1518339506
Name:CHARLES, TRINETTE
Entity Type:Individual
Prefix:
First Name:TRINETTE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRINETTE
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-4914
Mailing Address - Country:US
Mailing Address - Phone:843-431-1100
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-4914
Practice Address - Country:US
Practice Address - Phone:843-431-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1205925567OtherPEE DEE MENTAL HEALTH CENTER