Provider Demographics
NPI:1346808706
Name:THREATT, CHARLES JAMES III (LPCC, PPS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JAMES
Last Name:THREATT
Suffix:III
Gender:M
Credentials:LPCC, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 ORCHARD GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5661
Mailing Address - Country:US
Mailing Address - Phone:510-255-0335
Mailing Address - Fax:
Practice Address - Street 1:1277 ORCHARD GLEN CIR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5661
Practice Address - Country:US
Practice Address - Phone:510-255-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional