Provider Demographics
NPI:1861663825
Name:CHARLES, LANNY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LANNY
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 POPLAR AVE.
Mailing Address - Street 2:SERENITY RECOVERY CENTERS
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-521-1131
Mailing Address - Fax:901-746-9643
Practice Address - Street 1:1094 POPLAR AVE.
Practice Address - Street 2:SERENITY RECOVERY CENTERS
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-521-1131
Practice Address - Fax:901-746-9643
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AR1811-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)