Provider Demographics
NPI:1114797867
Name:STYRON, CHARLOTTE J (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:J
Last Name:STYRON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:J
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2713 DEERFIELD CRESCENT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2447
Mailing Address - Country:US
Mailing Address - Phone:757-956-6100
Mailing Address - Fax:757-956-6101
Practice Address - Street 1:3217 WESTERN BRANCH BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5235
Practice Address - Country:US
Practice Address - Phone:757-956-6100
Practice Address - Fax:757-956-6101
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601655760Medicaid