Healthcare Provider Details

I. General information

NPI: 1528532280
Provider Name (Legal Business Name): CHARLOTTE LIVELY LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOSPITAL DR
ATHENS OH
45701-2301
US

IV. Provider business mailing address

PO BOX 5
THE PLAINS OH
45780-0005
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-3091
  • Fax: 740-773-3985
Mailing address:
  • Phone: 740-645-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014631
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30918
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2203481
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSX61313303
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: