Healthcare Provider Details

I. General information

NPI: 1821078908
Provider Name (Legal Business Name): CHARLES DAVIES AMOS ED.D., MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4603
US

IV. Provider business mailing address

1937 FLINTLOCK TER W
COLORADO SPRINGS CO
80920-3813
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7085
  • Fax:
Mailing address:
  • Phone: 719-548-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991090
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: