Provider Demographics
NPI:1932897055
Name:WARREN, CHARLES WALTER
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WALTER
Last Name:WARREN
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 1:101 BRADFORD RD STE 330
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6938
Mailing Address - Country:US
Mailing Address - Phone:828-450-6756
Mailing Address - Fax:
Practice Address - Street 1:101 BRADFORD RD STE 330
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6938
Practice Address - Country:US
Practice Address - Phone:828-450-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health