Provider Demographics
NPI:1407820277
Name:FOLKERS, CHARLES ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERIC
Last Name:FOLKERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 W SPENCER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9379
Mailing Address - Country:US
Mailing Address - Phone:850-994-7872
Mailing Address - Fax:850-469-1111
Practice Address - Street 1:216 S TARRAGONA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6509
Practice Address - Country:US
Practice Address - Phone:850-469-1111
Practice Address - Fax:850-469-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74088Medicare NSC