Healthcare Provider Details

I. General information

NPI: 1922175355
Provider Name (Legal Business Name): CHARLES RICHARD PANTHER MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PENNSYLVANIA AVE
CANTON NC
28716
US

IV. Provider business mailing address

30 PENNSYLVANIA AVE
CANTON NC
28716
US

V. Phone/Fax

Practice location:
  • Phone: 828-538-1383
  • Fax:
Mailing address:
  • Phone: 828-538-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004383
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: