Healthcare Provider Details

I. General information

NPI: 1427150630
Provider Name (Legal Business Name): THE CHARLESTON CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 BERKMAR DR STE A1
CHARLOTTESVILLE VA
22901-1593
US

IV. Provider business mailing address

3040 BERKMAR DR STE A1
CHARLOTTESVILLE VA
22901-1593
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-8628
  • Fax: 434-979-8536
Mailing address:
  • Phone: 434-979-8628
  • Fax: 434-979-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberN/A
License Number State

VIII. Authorized Official

Name: MS. KERRIE LYNN MANTHEY
Title or Position: DIRECTOR
Credential: M.S., CCC-SLP
Phone: 434-979-8628