Provider Demographics
NPI:1053868745
Name:ROWE, CHARLES KEITH (RADT-I)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:KEITH
Last Name:ROWE
Suffix:
Gender:M
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17825 ARDISIA CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1250
Mailing Address - Country:US
Mailing Address - Phone:858-275-3154
Mailing Address - Fax:
Practice Address - Street 1:1180 3RD AVE
Practice Address - Street 2:SUITE C-3
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3139
Practice Address - Country:US
Practice Address - Phone:619-691-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)