Healthcare Provider Details

I. General information

NPI: 1255298154
Provider Name (Legal Business Name): CHARLES Z BARWON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12606 ERIKA HILL PL
MIDLOTHIAN VA
23112-6857
US

IV. Provider business mailing address

12606 ERIKA HILL PL
MIDLOTHIAN VA
23112-6857
US

V. Phone/Fax

Practice location:
  • Phone: 469-321-5160
  • Fax:
Mailing address:
  • Phone: 469-321-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701015708
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: