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General NPI Number Information
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NPI Number | 1306855853
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Entity Type | Organization
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Legal Business Name | CHARIS CENTER
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 4041 BAHIA VISTA ST.
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City | SARASOTA
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State | FL
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Zip | 34233
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Country | US
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Telephone | 941-378-1549
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Fax | 940-342-1781
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Provider Business Mailing Address
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Address Line | 4041 BAHIA VISTA STREET
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City | SARASOTA
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State | FL
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Zip | 34232
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Country | US
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Telephone | 941-378-1549
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Fax | 941-342-1781
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Authorized Official
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Title or Position | PRESIDENT/BOARD OF DIRECTORS
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Name | MR. DALE STOLL
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Credential |
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Telephone | 941-378-1549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | FL
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