Provider Demographics
NPI:1689807380
Name:CHARLOTTE CALLENS, LLC
Entity type:Organization
Organization Name:CHARLOTTE CALLENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS
Authorized Official - Phone:301-812-1715
Mailing Address - Street 1:104 FORBES ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1516
Mailing Address - Country:US
Mailing Address - Phone:301-812-1715
Mailing Address - Fax:
Practice Address - Street 1:104 FORBES ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1516
Practice Address - Country:US
Practice Address - Phone:301-812-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty