Provider Demographics
NPI:1780082016
Name:VELEZ, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4053 PEERLESS RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3445
Mailing Address - Country:US
Mailing Address - Phone:423-883-0308
Mailing Address - Fax:423-296-6384
Practice Address - Street 1:6110 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1894
Practice Address - Country:US
Practice Address - Phone:888-291-4357
Practice Address - Fax:423-296-6384
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health