Provider Demographics
NPI:1740716844
Name:PENNIE, CHARMAILE (LCSWA)
Entity type:Individual
Prefix:
First Name:CHARMAILE
Middle Name:
Last Name:PENNIE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 ANTHEM LN UNIT 9101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0043
Mailing Address - Country:US
Mailing Address - Phone:910-813-7304
Mailing Address - Fax:
Practice Address - Street 1:705 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7020
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25843101YA0400X
NCP0112841041C0700X
NCP0156781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)