Provider Demographics
NPI:1851791149
Name:MURPHY, CHARLES
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 FORBES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4807
Mailing Address - Country:US
Mailing Address - Phone:301-306-4590
Mailing Address - Fax:
Practice Address - Street 1:4601 FORBES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4807
Practice Address - Country:US
Practice Address - Phone:301-306-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA056101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)