Provider Demographics
NPI:1770238545
Name:YEARWOOD, CHARLA JOYCE CANNON (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:JOYCE CANNON
Last Name:YEARWOOD
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 1:9165 OTIS AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2307
Mailing Address - Country:US
Mailing Address - Phone:317-402-1604
Mailing Address - Fax:
Practice Address - Street 1:9165 OTIS AVE STE 109
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2307
Practice Address - Country:US
Practice Address - Phone:317-207-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006911A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical