Healthcare Provider Details

I. General information

NPI: 1407180581
Provider Name (Legal Business Name): CHARLOTTE SIMMS DABBS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT SUITE 305
TOLEDO OH
43606-1306
US

IV. Provider business mailing address

3454 OAK ALLEY CT SUITE 305
TOLEDO OH
43606-1306
US

V. Phone/Fax

Practice location:
  • Phone: 419-534-2468
  • Fax: 419-534-2397
Mailing address:
  • Phone: 419-534-2468
  • Fax: 419-534-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6489
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6489
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number6489
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: