Provider Demographics
NPI:1750910907
Name:CALLY, CHARLOTTE ELLEN (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ELLEN
Last Name:CALLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 VILLAGE GREEN BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3630
Mailing Address - Country:US
Mailing Address - Phone:517-881-2651
Mailing Address - Fax:
Practice Address - Street 1:220 COLLINGWOOD ST STE 130
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3842
Practice Address - Country:US
Practice Address - Phone:734-786-2626
Practice Address - Fax:734-997-5015
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011074841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical