Provider Demographics
NPI:1124203021
Name:STOKES-WILLIAMS, CHARU (LICSW, BCD, PHD)
Entity type:Individual
Prefix:
First Name:CHARU
Middle Name:
Last Name:STOKES-WILLIAMS
Suffix:
Gender:F
Credentials:LICSW, BCD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-2273
Mailing Address - Fax:
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1167831041C0700X
MA216985104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000023532OtherBMC
MA042611055OtherTAX ID
MA1303287OtherMBHP
MA172524OtherTRICARE
MA1303287Medicaid
MA1004745OtherNHP
MA703136OtherTUFTS
MAM18633OtherBLUE CROSS BLUE SHIELD