Healthcare Provider Details

I. General information

NPI: 1174032015
Provider Name (Legal Business Name): CHARLOTTE ANN KEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 MENDOCINO CT
ATWATER CA
95301-4230
US

IV. Provider business mailing address

559 MENDOCINO CT
ATWATER CA
95301-4230
US

V. Phone/Fax

Practice location:
  • Phone: 209-357-5200
  • Fax: 209-357-5279
Mailing address:
  • Phone: 209-357-5200
  • Fax: 209-357-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI07590417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: