Doctor Name: | JESSICA BROOK CHARLTON |
NPI Number: | 1104273077 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C.A. |
License Number: | LPCCCA00225092 |
Business Practice Address: | 1525 Cuba Rd Mayfield, KY - 420666809 |
Business Phone Number: | 2702472588 |
Business Fax Number: | |
Mailing Address: | 1525 Cuba Rd, MAYFIELD |
State: | KY |
Postal Code: | 420666809 |
Phone Number: | 2702472588 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2016 |
NPI Last Update Date: | 05/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPCCCA00225092 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |