Provider Demographics
NPI:1215916523
Name:DUNLOP, CHARLES ROBERT (SOCIAL WORK, LISW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROBERT
Last Name:DUNLOP
Suffix:
Gender:M
Credentials:SOCIAL WORK, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:COUNSELING CENTERS FOR CENTRAL IOWA
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-241-2300
Mailing Address - Fax:515-241-2305
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:COUNSELING CENTERS FOR CENTRAL IOWA
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-241-2300
Practice Address - Fax:515-241-2305
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-10-22
Deactivation Date:2006-06-15
Deactivation Code:
Reactivation Date:2010-07-27
Provider Licenses
StateLicense IDTaxonomies
IA00914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI1205Medicare ID - Type Unspecified
IA545450002Medicare PIN
IAR90890Medicare UPIN