Provider Demographics
NPI:1700216553
Name:EASON, CHARLES (LISW-CP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:EASON
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 PENDLETON ST
Mailing Address - Street 2:SUITE #11
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3209
Mailing Address - Country:US
Mailing Address - Phone:864-751-3200
Mailing Address - Fax:
Practice Address - Street 1:811 PENDLETON ST
Practice Address - Street 2:SUITE #11
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3209
Practice Address - Country:US
Practice Address - Phone:864-751-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9525OtherLICENSE