Provider Demographics
NPI:1336562636
Name:STAMP, CHARLOTTE LOUISE
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:LOUISE
Last Name:STAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:LOUISE
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, PC/CR
Mailing Address - Street 1:1400 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1018
Mailing Address - Country:US
Mailing Address - Phone:330-747-0950
Mailing Address - Fax:
Practice Address - Street 1:1400 OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1018
Practice Address - Country:US
Practice Address - Phone:330-747-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor