Provider Demographics
NPI:1427692235
Name:BASEL, CHARLES HENRY III (LPCMH NCC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HENRY
Last Name:BASEL
Suffix:III
Gender:M
Credentials:LPCMH NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PATRICK HENRY LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-4004
Mailing Address - Country:US
Mailing Address - Phone:302-752-5265
Mailing Address - Fax:
Practice Address - Street 1:20 PATRICK HENRY LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4004
Practice Address - Country:US
Practice Address - Phone:302-752-5265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health