Provider Demographics
NPI:1982815247
Name:CHARLES, CLIFFORD HERBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:HERBERT
Last Name:CHARLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GUILDER CV
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6425
Mailing Address - Country:US
Mailing Address - Phone:919-544-8430
Mailing Address - Fax:
Practice Address - Street 1:8 GUILDER CV
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6425
Practice Address - Country:US
Practice Address - Phone:919-544-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1847103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical