Provider Demographics
NPI:1053913251
Name:MOLALI, CHARLOTTE GLENN (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:GLENN
Last Name:MOLALI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-3209
Mailing Address - Country:US
Mailing Address - Phone:259-272-0707
Mailing Address - Fax:
Practice Address - Street 1:191 SAND CREEK RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2215
Practice Address - Country:US
Practice Address - Phone:925-663-8158
Practice Address - Fax:925-523-0916
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1176211041C0700X
CA95960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical