Provider Demographics
NPI:1720335417
Name:CHARLESTON, ADRIENNE (LPA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:CHARLESTON
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2372
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2372
Mailing Address - Country:US
Mailing Address - Phone:919-346-4619
Mailing Address - Fax:
Practice Address - Street 1:5878 FARINGDON PL
Practice Address - Street 2:STE 11B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4589
Practice Address - Country:US
Practice Address - Phone:919-346-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4299103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling