Provider Demographics
NPI:1639367444
Name:FRYE, CHARLOTTE A (LMHC,LPC-MHSP,EDD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:A
Last Name:FRYE
Suffix:
Gender:F
Credentials:LMHC,LPC-MHSP,EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5450
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-0450
Mailing Address - Country:US
Mailing Address - Phone:865-806-4403
Mailing Address - Fax:
Practice Address - Street 1:3105 ESSARY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2409
Practice Address - Country:US
Practice Address - Phone:865-806-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8053101YM0800X
TNLPC0000003163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1534481Medicaid