Provider Demographics
NPI:1518380856
Name:APPOLON, CHARLES (LAPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:APPOLON
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 DAHLONEGA ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2410
Mailing Address - Country:US
Mailing Address - Phone:678-960-8938
Mailing Address - Fax:
Practice Address - Street 1:330 DAHLONEGA ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2410
Practice Address - Country:US
Practice Address - Phone:678-960-8938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional