Provider Demographics
NPI:1194906388
Name:PRICE, CHARLES WARREN SR (LCPCAC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WARREN
Last Name:PRICE
Suffix:SR
Gender:M
Credentials:LCPCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1701
Mailing Address - Country:US
Mailing Address - Phone:606-638-0222
Mailing Address - Fax:
Practice Address - Street 1:410 E MADISON ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1701
Practice Address - Country:US
Practice Address - Phone:606-638-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL05187748101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral