Healthcare Provider Details

I. General information

NPI: 1962369207
Provider Name (Legal Business Name): CHARLES AJ PARKHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

14 HIGHLAND AVE
STRUTHERS OH
44471-2321
US

IV. Provider business mailing address

14 HIGHLAND AVE
STRUTHERS OH
44471-2321
US

V. Phone/Fax

Practice location:
  • Phone: 330-307-3962
  • Fax:
Mailing address:
  • Phone: 330-307-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: