Provider Demographics
NPI:1568413458
Name:CHARNIN, DOREEN GAIL (LPC,NCC,CFT,MHDL)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:GAIL
Last Name:CHARNIN
Suffix:
Gender:F
Credentials:LPC,NCC,CFT,MHDL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CREEK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0916
Mailing Address - Country:US
Mailing Address - Phone:704-364-8002
Mailing Address - Fax:704-362-2030
Practice Address - Street 1:137 CREEK VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-0916
Practice Address - Country:US
Practice Address - Phone:704-364-8002
Practice Address - Fax:704-362-2030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102232Medicaid