Provider Demographics
NPI:1386728624
Name:STANNARD, CHARLES W (MSW LCWS LMFT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:STANNARD
Suffix:
Gender:M
Credentials:MSW LCWS LMFT
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:STANNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2014 DELTA BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303
Mailing Address - Country:US
Mailing Address - Phone:850-531-0432
Mailing Address - Fax:850-386-4583
Practice Address - Street 1:2014 DELTA BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-531-0432
Practice Address - Fax:850-386-4583
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW30311041C0700X
FLMT1156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist