Provider Demographics
NPI:1104870302
Name:GARNES, CHARLOTTE E (LPC)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:E
Last Name:GARNES
Suffix:
Gender:F
Credentials:LPC
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 6661
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-0661
Mailing Address - Country:US
Mailing Address - Phone:704-712-9071
Mailing Address - Fax:704-248-2946
Practice Address - Street 1:603 J CLYDE MORRIS BLVD
Practice Address - Street 2:STE 4
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1826
Practice Address - Country:US
Practice Address - Phone:704-712-9071
Practice Address - Fax:704-248-2946
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5195101YP2500X, 101YM0800X, 101YA0400X
VA0701005161101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103163Medicaid