Healthcare Provider Details

I. General information

NPI: 1104047182
Provider Name (Legal Business Name): CHARLES MAYS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR ST. 1121
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

4320 DIPLOMACY DR ST. 1121
ANCHORAGE AK
99508-5925
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-4956
  • Fax: 907-279-4133
Mailing address:
  • Phone: 907-729-4956
  • Fax: 907-279-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number615
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: