Provider Demographics
NPI:1790820256
Name:SKEAN, CHARLES THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:THOMAS
Last Name:SKEAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1504
Mailing Address - Country:US
Mailing Address - Phone:304-453-1633
Mailing Address - Fax:
Practice Address - Street 1:207 16TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7906
Practice Address - Country:US
Practice Address - Phone:606-329-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0226101YA0400X
KY1401041C0700X
WVDP 004500881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical