Provider Demographics
NPI:1851964670
Name:INGLETON, CHARLES (CADC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:INGLETON
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 EASEDALE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2488
Mailing Address - Country:US
Mailing Address - Phone:201-362-7606
Mailing Address - Fax:
Practice Address - Street 1:84 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7143
Practice Address - Country:US
Practice Address - Phone:201-487-4700
Practice Address - Fax:201-487-4787
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00078000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)