Healthcare Provider Details

I. General information

NPI: 1821760588
Provider Name (Legal Business Name): AISHA N CHARLES JD, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ROBINS NEST PL
ROSWELL NM
88201-9511
US

IV. Provider business mailing address

5900 BALCONES DR STE 5379
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 737-238-0127
  • Fax:
Mailing address:
  • Phone: 737-238-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSX61458917
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0376
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number67577
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: