Provider Demographics
NPI:1568692002
Name:CHARLES, ELIA HEIDIANN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIA
Middle Name:HEIDIANN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BRANDYWINE ST SE
Mailing Address - Street 2:UNIT 101
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3551
Mailing Address - Country:US
Mailing Address - Phone:202-629-3026
Mailing Address - Fax:
Practice Address - Street 1:9080 BEALE RD BLDG 623
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5633
Practice Address - Country:US
Practice Address - Phone:301-400-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500785801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical