Healthcare Provider Details

I. General information

NPI: 1669784757
Provider Name (Legal Business Name): NORA ELIZABETH CHARLES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 COLLEGE DRIVE BOX #5025
HATTIESBURG MS
39406-0001
US

IV. Provider business mailing address

118 COLLEGE DRIVE BOX #5025
HATTIESBURG MS
39406-0001
US

V. Phone/Fax

Practice location:
  • Phone: 601-266-4330
  • Fax:
Mailing address:
  • Phone: 601-266-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number571007
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number571007
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number571007
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number571007
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: