Provider Demographics
NPI:1952553174
Name:CHARLES, SOPHIA LOREN
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LOREN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2711
Mailing Address - Country:US
Mailing Address - Phone:410-908-0782
Mailing Address - Fax:410-944-7622
Practice Address - Street 1:7205 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2711
Practice Address - Country:US
Practice Address - Phone:410-908-0782
Practice Address - Fax:410-944-7622
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG086441041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool