Healthcare Provider Details

I. General information

NPI: 1841350923
Provider Name (Legal Business Name): CHARLOTTE PRESTON SANTA RN, CAP, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N PROSPECT ST
CRESCENT CITY FL
32112-2445
US

IV. Provider business mailing address

419 N PROSPECT ST
CRESCENT CITY FL
32112-2445
US

V. Phone/Fax

Practice location:
  • Phone: 386-698-2122
  • Fax: 386-698-2122
Mailing address:
  • Phone: 386-698-2122
  • Fax: 386-698-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP298
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: