MEDICARE: KARLA CHARLES

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	101YP2500X	Professional Counselor	37PC00741700	NJ
2	101YP2500X	Professional Counselor	0701008829	VA

General Provider Information

NPI Number	:	1649802190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA CHARLES

Provider Business Mailing Address
First Line	:	1712 VAN WICKLE DR
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-2609
Country	:	US
Telephone Number	:	804-564-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 VAN WICKLE DR
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-2609
Country	:	US
Telephone Number	:	804-564-8460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	04/10/2023

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Directions to “ KARLA CHARLES ” Practice Location

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