Provider Demographics
NPI:1922409952
Name:CHARLES, KRIS (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15708 MCCONNELLSVILL RD
Mailing Address - Street 2:NOBLE CORRECTIONAL INSTITUTION
Mailing Address - City:CALDWELL OHIO
Mailing Address - State:OH
Mailing Address - Zip Code:43724
Mailing Address - Country:US
Mailing Address - Phone:740-732-5188
Mailing Address - Fax:
Practice Address - Street 1:15708 MCCONNELLSVILL RD
Practice Address - Street 2:NOBLE CORRECTIONAL INSTITUTION
Practice Address - City:CALDWELL OHIO
Practice Address - State:OH
Practice Address - Zip Code:43724
Practice Address - Country:US
Practice Address - Phone:740-732-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0005834 -S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health