Doctor Name: | SUSAN CHARLES |
NPI Number: | 1023434800 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180008032 |
Business Practice Address: | 610 Crystal Point Dr Ste 3 Crystal Lake, IL - 600141400 |
Business Phone Number: | 8159811979 |
Business Fax Number: | |
Mailing Address: | 320 Ridge Ave, CRYSTAL LAKE |
State: | IL |
Postal Code: | 600143421 |
Phone Number: | 8159811979 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2014 |
NPI Last Update Date: | 03/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180008032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |