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General NPI Number Information
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NPI Number | 1821782723
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Entity Type | Individual
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Provider Name | CHARLES ALLEN MASON MA MCAP
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Gender | Male
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 4320 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-6610
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Country | US
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Telephone | 352-505-2432
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Fax |
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Provider Business Mailing Address
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Address Line | 528 ELLIOT DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4016
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Country | US
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Telephone | 321-536-2690
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Fax |
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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 | MCAP100879
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License Number State | FL
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