Provider Demographics
NPI:1265530885
Name:LENT, CHARLES SIDNEY (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:SIDNEY
Last Name:LENT
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2521
Mailing Address - Country:US
Mailing Address - Phone:530-918-9201
Mailing Address - Fax:
Practice Address - Street 1:38 PARK WAY
Practice Address - Street 2:
Practice Address - City:HAPPY CAMP
Practice Address - State:CA
Practice Address - Zip Code:96039
Practice Address - Country:US
Practice Address - Phone:530-493-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 187071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 18707Medicaid