Provider Demographics
NPI:1821760588
Name:CHARLES, AISHA N (JD, LCSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:N
Last Name:CHARLES
Suffix:
Gender:F
Credentials:JD, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 5379
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:737-238-0127
Mailing Address - Fax:
Practice Address - Street 1:1 MIYOKO POINT SPUR RD
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-8740
Practice Address - Country:US
Practice Address - Phone:737-238-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASX614589171041C0700X
TX675771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical