Provider Demographics
NPI:1396142535
Name:BURLEW, CHARLENE (LCSW, LISW, LCDC3,)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:BURLEW
Suffix:
Gender:F
Credentials:LCSW, LISW, LCDC3,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3424
Mailing Address - Country:US
Mailing Address - Phone:859-446-7833
Mailing Address - Fax:859-446-7831
Practice Address - Street 1:226 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3424
Practice Address - Country:US
Practice Address - Phone:859-446-7833
Practice Address - Fax:859-446-7831
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1336101YA0400X
KY39541041C0700X
OHI.14404161041C0700X
OH131178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)