MEDICARE: MRS. CHARLOTTE PRESTON SANTA RN, CAP, LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAP298	FL
2	1041C0700X	Clinical Social Worker	SW2808	FL

General Provider Information

NPI Number	:	1841350923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE PRESTON SANTA RN, CAP, LCSW

Provider Business Mailing Address
First Line	:	419 N PROSPECT ST
Second Line	:
City	:	CRESCENT CITY
State	:	FL
Zip	:	32112-2445
Country	:	US
Telephone Number	:	386-698-2122
Fax Number	:	386-698-2122

Provider Business Practice Location Address
First Line	:	419 N PROSPECT ST
Second Line	:
City	:	CRESCENT CITY
State	:	FL
Zip	:	32112-2445
Country	:	US
Telephone Number	:	386-698-2122
Fax Number	:	386-698-2122

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/11/2025

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