Healthcare Provider Details

I. General information

NPI: 1528229671
Provider Name (Legal Business Name): CHARITY ANN PLAXTON HENNINGS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 BUSINESS CENTER DR SUITE 11
SAN BERNARDINO CA
92408-3465
US

IV. Provider business mailing address

PO BOX 659
BRYN MAWR CA
92318-0659
US

V. Phone/Fax

Practice location:
  • Phone: 909-553-0547
  • Fax: 909-384-0734
Mailing address:
  • Phone: 909-553-0547
  • Fax: 909-384-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: