Provider Demographics
NPI:1750031837
Name:CHRISP, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CHRISP
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:CHRISP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:PO BOX 3159
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3159
Mailing Address - Country:US
Mailing Address - Phone:803-312-2416
Mailing Address - Fax:
Practice Address - Street 1:1734 COLUMBIA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6608
Practice Address - Country:US
Practice Address - Phone:180-331-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC148411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical