Provider Demographics
NPI:1649408311
Name:CHARTER, DEANA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:LYNN
Last Name:CHARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 W BOSAL DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5286
Mailing Address - Country:US
Mailing Address - Phone:480-241-2720
Mailing Address - Fax:480-839-4692
Practice Address - Street 1:1147 W BOSAL DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5286
Practice Address - Country:US
Practice Address - Phone:480-241-2720
Practice Address - Fax:480-839-4692
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional