MEDICARE: CHARIS CENTER-SOUTH, INC.

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467485524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARIS CENTER-SOUTH, INC.

Provider Business Mailing Address
First Line	:	6 PLYMPTON ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1602
Country	:	US
Telephone Number	:	508-947-1901
Fax Number	:	508-923-3462

Provider Business Practice Location Address
First Line	:	6 PLYMPTON ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1602
Country	:	US
Telephone Number	:	508-947-1901
Fax Number	:	508-923-3462

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ERIC KENYON SWEITZER
Credential	:	PHD
Telephone Number	:	508-947-1901

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/14/2008

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