Provider Demographics
NPI:1952792772
Name:TALBOT, CHARMIAN (MA, LADC, CADC, SUD)
Entity Type:Individual
Prefix:MS
First Name:CHARMIAN
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:MA, LADC, CADC, SUD
Other - Prefix:
Other - First Name:CHARMIAN
Other - Middle Name:
Other - Last Name:TALBOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDP
Mailing Address - Street 1:151 LAWRENCE COURT
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878
Mailing Address - Country:US
Mailing Address - Phone:401-246-1195
Mailing Address - Fax:
Practice Address - Street 1:610 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1504
Practice Address - Country:US
Practice Address - Phone:401-307-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDPOO603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)