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General NPI Number Information
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NPI Number | 1689807380
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Entity Type | Organization
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Legal Business Name | CHARLOTTE CALLENS, LLC
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 104 FORBES ST SUITE 205
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1516
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Country | US
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Telephone | 301-812-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 104 FORBES ST SUITE 205
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1516
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Country | US
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Telephone | 301-812-1715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLOTTE CALLENS
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Credential | PHD, MS
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Telephone | 301-812-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | MD
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