Provider Demographics
NPI:1942318779
Name:CRACE, CHARLENE ELLEN (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:ELLEN
Last Name:CRACE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 BANEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7398
Mailing Address - Country:US
Mailing Address - Phone:614-257-5542
Mailing Address - Fax:614-257-5289
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:CHALMERS P. WYLIE VA AMBULATORY CARE CENTER
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5542
Practice Address - Fax:614-257-5289
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08001641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical