Provider Demographics
NPI:1528229671
Name:PLAXTON HENNINGS, CHARITY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:ANN
Last Name:PLAXTON HENNINGS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:CA
Mailing Address - Zip Code:92318-0659
Mailing Address - Country:US
Mailing Address - Phone:909-553-0547
Mailing Address - Fax:909-384-0734
Practice Address - Street 1:1881 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-553-0547
Practice Address - Fax:909-384-0734
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20627103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20627OtherLICENSE NUMBER