Provider Demographics
NPI:1598150260
Name:CHARLES, SANDRA P (ICADC, CADCII, CCS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:P
Last Name:CHARLES
Suffix:
Gender:F
Credentials:ICADC, CADCII, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ROSEINE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8686
Mailing Address - Country:US
Mailing Address - Phone:850-774-8646
Mailing Address - Fax:
Practice Address - Street 1:404 ROSEINE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8686
Practice Address - Country:US
Practice Address - Phone:850-774-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA083101Y00000X
GA439101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor