Provider Demographics
NPI:1336264753
Name:ALCORN, CHARLES EDGAR III (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDGAR
Last Name:ALCORN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 THORNHILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2706
Mailing Address - Country:US
Mailing Address - Phone:630-752-9750
Mailing Address - Fax:630-752-9768
Practice Address - Street 1:507 THORNHILL DR STE A
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2706
Practice Address - Country:US
Practice Address - Phone:630-752-9750
Practice Address - Fax:630-752-9768
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral