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General NPI Number Information
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NPI Number | 1942318779
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Entity Type | Individual
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Provider Name | CHARLENE ELLEN CRACE M.S.W., L.I.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 420 N JAMES RD CHALMERS P. WYLIE VA AMBULATORY CARE CENTER
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City | COLUMBUS
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State | OH
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Zip | 43219-1834
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Country | US
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Telephone | 614-257-5542
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Fax | 614-257-5289
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Provider Business Mailing Address
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Address Line | 5462 BANEBERRY AVE
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City | COLUMBUS
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State | OH
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Zip | 43235-7398
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Country | US
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Telephone | 614-257-5542
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Fax | 614-257-5289
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0800164
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License Number State | OH
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