Provider Demographics
NPI:1205620374
Name:CRITTENDON, CHARTEASE
Entity type:Individual
Prefix:MS
First Name:CHARTEASE
Middle Name:
Last Name:CRITTENDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 COUNTY ROAD 141
Mailing Address - Street 2:
Mailing Address - City:TOWN CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35672-4101
Mailing Address - Country:US
Mailing Address - Phone:256-226-0931
Mailing Address - Fax:
Practice Address - Street 1:5021 COUNTY ROAD 141
Practice Address - Street 2:
Practice Address - City:TOWN CREEK
Practice Address - State:AL
Practice Address - Zip Code:35672-4101
Practice Address - Country:US
Practice Address - Phone:256-226-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician