Provider Demographics
NPI:1841350923
Name:SANTA, CHARLOTTE PRESTON (RN, CAP, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:PRESTON
Last Name:SANTA
Suffix:
Gender:F
Credentials:RN, CAP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-2445
Mailing Address - Country:US
Mailing Address - Phone:386-698-2122
Mailing Address - Fax:386-698-2122
Practice Address - Street 1:419 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2445
Practice Address - Country:US
Practice Address - Phone:386-698-2122
Practice Address - Fax:386-698-2122
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP298101YA0400X
FLSW28081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4241Medicare ID - Type UnspecifiedPROVIDER