Provider Demographics
NPI:1821248592
Name:FAIRCHILD, CHARLOTTE K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:K
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-1603
Mailing Address - Country:US
Mailing Address - Phone:918-429-8224
Mailing Address - Fax:
Practice Address - Street 1:1011 HONOR HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-384-4547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4092104100000X
OK1857104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker