Provider Demographics
NPI:1679285548
Name:CHARLES, LORENE IRENE (AMFT)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:IRENE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 27TH AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1807
Mailing Address - Country:US
Mailing Address - Phone:714-726-1939
Mailing Address - Fax:
Practice Address - Street 1:494 27TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1801
Practice Address - Country:US
Practice Address - Phone:714-726-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist