Provider Demographics
NPI:1780371823
Name:SMILEY, CHARLES BEIVEN (CSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BEIVEN
Last Name:SMILEY
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 EVANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1965
Mailing Address - Country:US
Mailing Address - Phone:502-451-1221
Mailing Address - Fax:502-451-1337
Practice Address - Street 1:1028 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1667
Practice Address - Country:US
Practice Address - Phone:502-451-1221
Practice Address - Fax:502-451-1337
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2554271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical