MEDICARE: CHARLENE COCHRAN 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	1041C0700X	Clinical Social Worker	3441	KY

General Provider Information

NPI Number	:	1881960953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE COCHRAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 538622
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-8622
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

Provider Business Practice Location Address
First Line	:	390 PARK AVE
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41701-9548
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

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

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	09/19/2019

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Directions to “ CHARLENE COCHRAN LCSW” Practice Location

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