Provider Demographics
NPI:1689151524
Name:WIMBISH, CHARLENE J
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:J
Last Name:WIMBISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2827
Mailing Address - Country:US
Mailing Address - Phone:757-452-4356
Mailing Address - Fax:757-512-6251
Practice Address - Street 1:1499 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2827
Practice Address - Country:US
Practice Address - Phone:757-452-4356
Practice Address - Fax:757-512-6251
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health