Provider Demographics
NPI:1629461926
Name:INCLAN, CHARITY
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:INCLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:
Other - Last Name:CARRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1825 E THELBORN ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1442
Mailing Address - Country:US
Mailing Address - Phone:626-915-3844
Mailing Address - Fax:
Practice Address - Street 1:1825 E THELBORN ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1442
Practice Address - Country:US
Practice Address - Phone:626-915-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)