Provider Demographics
NPI:1821782723
Name:MASON, CHARLES ALLEN (MA MCAP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALLEN
Last Name:MASON
Suffix:
Gender:M
Credentials:MA MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 ELLIOT DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4016
Mailing Address - Country:US
Mailing Address - Phone:321-536-2690
Mailing Address - Fax:
Practice Address - Street 1:4320 S HOPKINS AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6610
Practice Address - Country:US
Practice Address - Phone:352-505-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100879101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)