Provider Demographics
NPI:1609230614
Name:MAHAN, CHARLENE (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:MAHAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 ALOMA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3752
Mailing Address - Country:US
Mailing Address - Phone:407-719-7782
Mailing Address - Fax:
Practice Address - Street 1:420 SHORT PINE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-6249
Practice Address - Country:US
Practice Address - Phone:407-900-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health