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General NPI Number Information
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NPI Number | 1790082725
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Entity Type | Individual
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Provider Name | JOHN ADRIAN CHARLES LCSW, ADC-II
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Gender | Male
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT GEORGE G MEADE
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State | MD
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Zip | 20755-7081
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Country | US
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Telephone | 301-677-8441
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Fax | 301-677-8176
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Provider Business Mailing Address
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Address Line | 2480 LLEWELLYN AVENUE KIMBROUGH AMBULATORY CARE CENTER
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City | FORT GEORGE G. MEADE
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State | MD
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Zip | 20755-5800
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Country | US
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Telephone | 301-677-8441
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Fax | 301-677-8176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 081256
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007446
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License Number State | VA
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