Healthcare Provider Details

I. General information

NPI: 1174540009
Provider Name (Legal Business Name): CHARLES HARRY WINGFIELD LCSW CACIII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E SPAULDING AVE STE 4
PUEBLO WEST CO
81007-1668
US

IV. Provider business mailing address

44 E SPAULDING AVE STE 4
PUEBLO WEST CO
81007-1668
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-9039
  • Fax: 719-561-8752
Mailing address:
  • Phone: 719-251-0398
  • Fax: 719-547-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2049
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number991320
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: