Provider Demographics
NPI:1588458525
Name:CHARLES, DEANNA RUTH (LSW)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:RUTH
Last Name:CHARLES
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 US ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-4200
Mailing Address - Country:US
Mailing Address - Phone:815-582-6858
Mailing Address - Fax:
Practice Address - Street 1:101 CHITTYVILLE RD
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3552
Practice Address - Country:US
Practice Address - Phone:618-727-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109965104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker