Provider Demographics
NPI:1336897289
Name:LURCH WINSTON, CHARLOTTE MORIEA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MORIEA
Last Name:LURCH WINSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:MORIEA
Other - Last Name:LURCH WINSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4050 HIGHWAY 42 # 157
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4105
Mailing Address - Country:US
Mailing Address - Phone:770-401-9660
Mailing Address - Fax:
Practice Address - Street 1:4050 HIGHWAY 42 # 157
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-4105
Practice Address - Country:US
Practice Address - Phone:770-927-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0078961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical