Provider Demographics
NPI:1730484254
Name:ANGIE CHARTER, LCSW, LLC
Entity Type:Organization
Organization Name:ANGIE CHARTER, LCSW, LLC
Other - Org Name:PRESENCE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTER
Authorized Official - Suffix:I
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-338-3786
Mailing Address - Street 1:421 W PLUMB LN
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3766
Mailing Address - Country:US
Mailing Address - Phone:775-338-3786
Mailing Address - Fax:775-354-1132
Practice Address - Street 1:421 W PLUMB LN
Practice Address - Street 2:SUITE A-5
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3766
Practice Address - Country:US
Practice Address - Phone:775-338-3786
Practice Address - Fax:775-453-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5319-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003062027Medicaid