Healthcare Provider Details

I. General information

NPI: 1255219481
Provider Name (Legal Business Name): CHARLENE VERONICA CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 BERESFORD CREEK ST
DANIEL ISLAND SC
29492-7518
US

IV. Provider business mailing address

232 BERESFORD CREEK ST
DANIEL ISLAND SC
29492-7518
US

V. Phone/Fax

Practice location:
  • Phone: 203-260-8769
  • Fax:
Mailing address:
  • Phone: 203-260-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13319
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: