Provider Demographics
NPI:1215660600
Name:HARTS, CHARLOTTE ANNA
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANNA
Last Name:HARTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARLOTTE
Other - Middle Name:ANNA
Other - Last Name:WARTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2102 S RIDGEWOOD AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-4230
Mailing Address - Country:US
Mailing Address - Phone:904-270-9181
Mailing Address - Fax:
Practice Address - Street 1:2102 S RIDGEWOOD AVE STE 17
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-4230
Practice Address - Country:US
Practice Address - Phone:904-270-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health