Provider Demographics
NPI:1790156735
Name:BALDWIN, CHARLIE EDWARDS (LPCA)
Entity Type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:EDWARDS
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 W BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9437
Mailing Address - Country:US
Mailing Address - Phone:919-923-3922
Mailing Address - Fax:
Practice Address - Street 1:6 W BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9437
Practice Address - Country:US
Practice Address - Phone:919-923-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional