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NPI Code Detail

MEDICARE: CHARLES MCKNIGHT LCDC

MEDICARE: CHARLES MCKNIGHT LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor13489TX

General Provider Information

NPI Number : 1386198604
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES MCKNIGHT LCDC
Provider Business Mailing Address
First Line : 322 MONTAGUE AVE
Second Line :
City : SAN ANGELO
State : TX
Zip : 76905-5110
Country : US
Telephone Number : 325-224-3481
Fax Number : 325-224-4923
Provider Business Practice Location Address
First Line : 3553 W HOUSTON HARTE EXPY
Second Line :
City : SAN ANGELO
State : TX
Zip : 76901-2664
Country : US
Telephone Number : 325-224-3481
Fax Number : 325-224-4923
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2016
Last Update Date : 08/04/2016

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