Provider Demographics
NPI:1649532458
Name:SOLOMONSON, CHARLES WILLIAM (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:SOLOMONSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CENTER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3634
Mailing Address - Country:US
Mailing Address - Phone:847-525-3530
Mailing Address - Fax:
Practice Address - Street 1:137 CENTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3634
Practice Address - Country:US
Practice Address - Phone:847-525-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490166301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical