Provider Demographics
NPI:1811400740
Name:MATTINGLY, CHARITY DANIELLE (MSW)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:DANIELLE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:DANIELLE
Other - Last Name:MATTINGLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:651 STOWE CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-0508
Mailing Address - Country:US
Mailing Address - Phone:931-503-0777
Mailing Address - Fax:
Practice Address - Street 1:651 STOWE CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-0508
Practice Address - Country:US
Practice Address - Phone:931-503-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health