Provider Demographics
NPI:1730463803
Name:ADLETA, CHARLES DEREK (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DEREK
Last Name:ADLETA
Suffix:
Gender:M
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 MCKINNEY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8212
Mailing Address - Country:US
Mailing Address - Phone:214-697-3997
Mailing Address - Fax:214-521-9172
Practice Address - Street 1:4054 MCKINNEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8212
Practice Address - Country:US
Practice Address - Phone:214-697-3997
Practice Address - Fax:214-521-9172
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist