Provider Demographics
NPI:1740818152
Name:LABIK, CHARLLEY L
Entity type:Individual
Prefix:
First Name:CHARLLEY
Middle Name:L
Last Name:LABIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2146
Mailing Address - Country:US
Mailing Address - Phone:610-933-8110
Mailing Address - Fax:
Practice Address - Street 1:100 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2146
Practice Address - Country:US
Practice Address - Phone:610-933-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional