Provider Demographics
NPI:1942570817
Name:CHARLEY, ANDRE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:CHARLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20726 WESTOVER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5621
Mailing Address - Country:US
Mailing Address - Phone:313-587-9869
Mailing Address - Fax:313-587-9869
Practice Address - Street 1:22511 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4115
Practice Address - Country:US
Practice Address - Phone:313-587-9869
Practice Address - Fax:313-209-8989
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085944172V00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker