Provider Demographics
NPI:1740593037
Name:PHIPPS, CHARLENE MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARIA
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2464
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-2464
Mailing Address - Country:US
Mailing Address - Phone:707-761-2658
Mailing Address - Fax:
Practice Address - Street 1:1000 TEXAS ST STE D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5700
Practice Address - Country:US
Practice Address - Phone:707-419-3277
Practice Address - Fax:707-240-0095
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 179841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical