Provider Demographics
NPI:1922360098
Name:DURANTE ALVAREZ, CHARLA MARIE (LCMHC, LCASA)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:MARIE
Last Name:DURANTE ALVAREZ
Suffix:
Gender:F
Credentials:LCMHC, LCASA
Other - Prefix:
Other - First Name:CHARLA
Other - Middle Name:MARIE
Other - Last Name:DURANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC LCASA
Mailing Address - Street 1:615 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:910-343-0145
Mailing Address - Fax:910-202-9966
Practice Address - Street 1:615 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6431
Practice Address - Country:US
Practice Address - Phone:910-343-0145
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22401101YA0400X
NCA9031101YM0800X
NC9031101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922360098Medicaid