Provider Demographics
NPI:1629762091
Name:CHARLES, DELPHINA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:DELPHINA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S BRAGG ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-2048
Mailing Address - Country:US
Mailing Address - Phone:828-655-2939
Mailing Address - Fax:
Practice Address - Street 1:108 S BRAGG ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-2048
Practice Address - Country:US
Practice Address - Phone:828-655-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health